2025 CPT code 66850
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Removal of lens material using phacofragmentation (mechanical or ultrasonic) with aspiration.
Modifiers may be applicable depending on the circumstances of the surgery (e.g., 51 for multiple procedures, 59 for distinct procedural service, 22 for increased procedural services, etc.).Refer to the official CPT manual for modifier guidance.
Medical necessity for 66850 is established when the lens material is impeding vision or interfering with other surgical procedures (such as a vitrectomy).Documentation must clearly demonstrate the need for lens removal to improve vision or facilitate other necessary surgical procedures.The severity of vision impairment should be documented.The patient's medical history and examination findings must support the need for surgical intervention.
The ophthalmologist or qualified surgeon performs the procedure. This includes preparing the patient (preoperative assessment and consent), administering anesthesia (either local or general), performing the surgical procedure (including incisions, lens fragmentation, aspiration, and wound closure), post-operative care (including monitoring intraocular pressure, administering antibiotics and applying an eye patch), and follow up care.
In simple words: This code covers a surgery to remove cloudy lens material from the eye. The doctor uses special tools to break up the cloudy part of the lens into tiny pieces, then uses suction to remove it. This helps improve vision if the cloudiness is interfering with sight.The eye is then patched and treated with antibiotic drops.
This CPT code, 66850, describes the surgical removal of lens material from the eye.The procedure involves using mechanical or ultrasonic methods (such as phacoemulsification) to fragment the lens material, followed by aspiration to remove the fragments. This is frequently performed to treat cataracts, where the lens becomes opaque, obscuring vision.The procedure typically involves an incision at the border of the sclera and cornea, insertion of a probe to break down the lens material, aspiration of the fragments, closure of the incision with sutures, restoration of intraocular pressure, and administration of a topical antibiotic.Note that additional codes may be necessary depending on the complexity of the case and the presence of other surgical procedures.
Example 1: A 70-year-old patient presents with a cataract in the right eye, significantly impacting their vision.The surgeon performs a phacoemulsification procedure (66850) to remove the cataractous lens material. Following the removal, an intraocular lens is implanted (code not included in 66850 and would require additional coding)., A 5-year-old child presents with a congenital cataract.The surgeon utilizes a pars plana approach for lens removal (66852 might be more appropriate depending on the specifics of the procedure). Aspiration and fragment removal are performed using phacoemulsification., During a vitrectomy (67036) for retinal detachment repair, the surgeon encounters significant lens material obscuring the surgical field.Phacofragmentation and aspiration (66850) are performed to clear the field of vision and complete the vitrectomy.Modifier -59 may be necessary to indicate this was a distinct surgical service.
Complete preoperative examination and documentation of the cataract, intraoperative notes detailing the surgical technique (e.g., phacoemulsification, type of aspiration), and post-operative findings are required.Imaging (e.g., pre-operative and post-operative optical coherence tomography (OCT)) may be necessary to support medical necessity. Patient history, visual acuity measurements (pre- and post-operative), and intraocular pressure readings are essential.
** Accurate documentation is critical for appropriate reimbursement.Consider using additional codes for any associated procedures, such as IOL insertion or vitrectomy.Always consult the most current CPT codebook and payer guidelines for specific billing requirements.The description of the procedure should be precise and thorough, and support the medical necessity for the performed procedure.
- Revenue Code: P4B (EYE PROCEDURE - CATARACT REMOVAL/LENS INSERTION)
- RVU: Consult the CMS Physician Fee Schedule for the most current RVU values.These values vary based on geographic location and other factors.
- Global Days: The global period for this procedure will vary depending on the surgeon and payer. Consult the payer's specific guidelines for details.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier may not be applicable as this is typically a complete procedure performed by the surgeon.
- Fee Schedule: Fee schedules vary by payer, location, and year. Consult historical fee schedules from CMS or other payers for historical reimbursement data.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital