2025 CPT code 66999
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Unlisted procedure on the anterior segment of the eye.
Modifiers may be applicable depending on the specific procedure and circumstances (e.g., -22 for increased procedural services, -50 for bilateral procedures, or others as clinically indicated).
The procedure must be medically necessary to treat a diagnosed condition and be consistent with accepted standards of ophthalmological care.Documentation must demonstrate the procedure's clinical necessity and its impact on the patient's condition.
The ophthalmologist or other qualified healthcare professional performs the procedure on the anterior segment of the eye.Responsibility includes pre-operative evaluation, the procedure itself, and post-operative care and follow-up.
In simple words: This code is for eye procedures in the front part of the eye that don't have a specific billing code.Doctors use this when a unique procedure is done that isn't already listed in the standard billing codes.They need to provide a lot of details about the procedure to get paid.
CPT code 66999 represents an unlisted procedure performed on the anterior segment of the eye.This code is used when no other specific CPT code accurately describes the procedure performed.Detailed documentation, including the procedure's nature, extent, and medical necessity, is crucial for proper reimbursement. The anterior segment comprises the structures in front of the eye's lens, including the cornea, iris, pupil, and anterior chamber.
Example 1: A patient presents with a rare corneal dystrophy requiring a unique surgical repair not covered by existing CPT codes.Code 66999 is used, with detailed documentation of the surgical technique, tissue samples, and post-operative course., During cataract surgery, an unexpected complication arises requiring an unanticipated procedure to address a tear in the iris.Because no specific CPT code exists, 66999 is appropriately billed, supported by thorough operative notes., A patient needs a minimally invasive glaucoma procedure, such as micro-goniotomy, where the standard codes do not fit the limited intervention.Code 66999 is billed with extensive documentation of the procedure's details to support the claim.
* Detailed operative report outlining the procedure's steps, instruments used, and any complications.* Pre-operative and post-operative diagnoses and findings.* Imaging studies (if applicable), such as OCT, ultrasound biomicroscopy.* Justification for using code 66999, explicitly stating why other codes are not applicable.* Patient's medical history and reason for the procedure.
** When billing with 66999, it's crucial to provide a detailed explanation of the procedure's rationale and cost.Clearly outlining the complexity of the procedure compared to similar coded procedures strengthens the justification for reimbursement.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: Variable; reimbursement depends on the complexity of the procedure and supporting documentation.No standard RVUs exist for unlisted codes like 66999.
- Global Days: Varies depending on the specific procedure;documentation should specify the global period if applicable.
- Payment Status: Active, but reimbursement is case-by-case and dependent on comprehensive documentation.
- Modifier TC rule: TC modifier may or may not apply depending on whether the service is primarily technical (TC) or professional (26).
- Fee Schedule: Reimbursement for code 66999 varies depending on payer, location, and the procedure performed.There is no fixed fee schedule for unlisted codes.
- Specialties:Ophthalmology
- Place of Service:Office, Ambulatory Surgical Center, Inpatient Hospital (depending on the clinical setting)