2025 CPT code 66987
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Complex extracapsular cataract removal with intraocular lens insertion, employing techniques like iris expansion or suture support, or performed during amblyogenic development; includes endoscopic cyclophotocoagulation.
Modifiers may apply depending on the circumstances of the procedure.Refer to the CPT manual and payer guidelines for details on appropriate modifier use (e.g., 50 for bilateral procedures, 59 for distinct procedures).
Medical necessity is established by the presence of a visually significant cataract impairing the patient's quality of life. In cases of glaucoma, the simultaneous treatment is medically necessary for the prevention or management of the condition.Documentation supporting the diagnosis and the need for the surgical intervention must be clear and comprehensive.
The ophthalmologist or a qualified surgeon performs the procedure. This includes pre-operative assessment, surgical execution, and post-operative care.
In simple words: This code covers a complex eye surgery to remove a clouded lens (cataract) and replace it with an artificial lens. It involves advanced techniques or tools and may be done in young children whose vision is still developing.The procedure also includes a laser treatment to help manage eye pressure.
This CPT code encompasses extracapsular cataract extraction and intraocular lens (IOL) implantation, characterized by complexity exceeding routine procedures.The complexity might involve the use of specialized devices (e.g., iris expansion device) or techniques (e.g., suture support for IOL, primary posterior capsulorrhexis). The procedure may also be performed on patients in the amblyogenic developmental stage.Additionally, it includes endoscopic cyclophotocoagulation to reduce intraocular pressure by shrinking the ciliary processes, often used to treat or prevent glaucoma.The procedure involves creating a small incision, removing the lens nucleus (potentially using phacoemulsification), evacuating the cortex, performing capsulotomy or capsulorrhexis, inserting the IOL (potentially with suture support), and closing the incision. Antibiotic and corticosteroid solutions are typically infused.
Example 1: A 70-year-old patient presents with a dense cataract and glaucoma. The surgeon performs a complex extracapsular cataract extraction with IOL implantation using an iris expansion device due to a small pupil. Endoscopic cyclophotocoagulation is performed simultaneously to treat glaucoma., A 6-month-old infant with a congenital cataract undergoes surgery.Due to the patient's age and the need for precision, the surgeon uses specialized microsurgical techniques, including suture support for IOL placement, along with endoscopic cyclophotocoagulation for glaucoma management., A 55-year-old patient with a complex cataract and zonular weakness requires suture support for IOL fixation during extracapsular cataract extraction. Endoscopic cyclophotocoagulation is included as a preventative measure for glaucoma.
* Comprehensive ophthalmological examination report, including visual acuity measurements, slit-lamp biomicroscopy, and gonioscopy.* Detailed surgical notes, documenting the techniques used, devices employed, and intraoperative findings.* Post-operative progress notes, including visual acuity, intraocular pressure measurements, and any complications.* Consent form for the procedure.* Images (if applicable) documenting the surgical steps and outcomes.
** The level of complexity for code 66987 is determined by the techniques and devices used during surgery, not merely the presence of a cataract.Proper documentation is crucial for accurate coding and reimbursement.
- Revenue Code: P4B (EYE PROCEDURE - CATARACT REMOVAL/LENS INSERTION)
- RVU: Refer to CMS guidelines and local payer reimbursement schedules for RVU and payment rate information.This varies based on geographic location, facility type (non-facility/facility), and other factors.
- Global Days: The global period will depend on payer and local policies.Consult payer-specific guidelines for exact details.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier may be applicable depending on the billing arrangements and payer rules.
- Fee Schedule: Fee schedules vary by payer, location, and date.Refer to historical fee schedules from your payer for accurate information.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office