Medical Billing for Cataract Surgery

Cataracts disease of the eye causes the clouding of the lens of the eyeball and removal of these lenses of the eye is called cataract surgery. It is observed that over half of the people in America over age 80 have either had a cataract or cataract surgery hence medical billing for cataract surgery accounts for a large volume of the claims that ophthalmology medical billing companies process.

In this brief, you will understand Medical Billing for Cataract Surgery with some of the main CPT codes.

CPT codes for Extraction of lens and lens material:

CPT Codes



Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration


Removal of lens material; intracapsular


Removal of lens material; extracapsular (other than 66840, 66850, 66852)

CPT codes for cataract extractions With implant:

CPT Codes



Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique, (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic development stage


Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure)


Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure) manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification)


Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract extraction


Exchange of intraocular lens

Disorders of the lens (H25-H28)


Age-related Cataract


Other Cataract


Other disorders of lens


Cataract in diseases classified elsewhere

ASCs determine which CPT and ICD-10 codes are most appropriate to report on the claim the operative report.

Documenting complex Cataract Surgery case

Most of the ophthalmologists fear to bill for a complex case (CPT code 66982) but you shouldn’t. You need to support the case with proper documentation. Although not every Medicare Administrative Contractor has a Local Coverage Determination policy for complex cataract surgery.

Following four questions to determine if your case is complex or not:

  • Is it a miotic pupil that will not dilate sufficiently thus requiring the use of special instruments?
  • Does the IOL need additional support, such as a capsular tension ring or intraocular sutures?
  • Is this a pediatrics case that includes the implantation of the IOL?
  • Is the cataract considered mature, requiring the use of dye?

If you find ”Yes” for any of the above questions then submit CPT code 66982. You must be aware that this code selection is not based on the difficulty of the case but rather on the use of additional devices or if you are operating on children.

Many times you know before surgery whether or not the case will be complex; however, if you determine intraoperatively, be sure the facility updates its claim and submits the case as “complex”. Both you and the facility should submit the same CPT code to the payer.

If you face difficulties in Medical Billing for Cataract Surgery then you can really on us, we have experienced coders in medical billing and coding and well-versed in the CPT and ICD-10 codes for ophthalmology.

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