CPT Code 66920

CPT code 66920 is a medical billing code for the surgical removal of a lens due to cataracts or other conditions.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 66920

CPT code 66920 is designated for the surgical procedure involving the extraction of the lens of the eye. This code is typically used when the lens is removed due to conditions such as cataracts, where the natural lens becomes opaque and impairs vision. The procedure can involve different techniques of lens removal, but the code covers the general act of extracting the lens without specifying the method used.

Does CPT 66920 Need a Modifier?

For CPT code 66920, which pertains to the extraction of a lens, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here is an ordered list of common modifiers that could be used with CPT code 66920 and the reasons for each:

1. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye underwent the procedure. Since eye surgeries are specific to each eye, indicating the correct side is crucial for accurate billing and medical records.

2. -50 (Bilateral Procedure): This modifier is used if the procedure was performed on both eyes during the same surgical session. It is important for reimbursement purposes as some payers may adjust the payment for bilateral procedures.

3. -22 (Increased Procedural Services): This modifier may be used if the procedure required a greater effort than typically required. Documentation must support the extra work and the reason why it was necessary.

4. -51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps in the adjustment of payment policies for additional procedures performed.

5. -59 (Distinct Procedural Service): Indicates that the procedure was distinct or independent from other services performed on the same day. This modifier is crucial for preventing payment denials due to the bundling of procedures.

6. -78 (Unplanned Return to the Operating Room): Used if a return to the operating room was required for a related procedure during the postoperative period. This helps in differentiating the claim from the global surgical package.

7. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if a new procedure (unrelated to the initial one) is performed while the patient is still in the postoperative period from a different surgery.

8. -24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Applicable if an unrelated evaluation and management service is performed during the postoperative period of a different procedure.

Each of these modifiers addresses specific billing and procedural nuances that can affect reimbursement and compliance. Proper documentation and justification for each modifier are essential to ensure accurate and timely payment.

CPT Code 66920 Medicare Reimbursement

CPT code 66920, which pertains to the extraction of a cataract lens, is generally reimbursed by Medicare. This procedure falls under covered surgical services when deemed medically necessary. The reimbursement amount for CPT code 66920 can vary based on the geographic location of the service provider and the specific Medicare administrative contractor (MAC) policies. However, it is important for healthcare providers to verify the coverage specifics, including any applicable deductibles and coinsurance that the patient might be responsible for, through their local MAC or by checking the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website. Additionally, documentation and compliance with Medicare guidelines are crucial to ensure proper reimbursement for this service.

Are You Being Underpaid for 66920 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize contracts and identify discrepancies down to specific CPT codes, such as 66920 for lens extraction procedures, RevFind ensures that every claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can secure the payments you are entitled to for each service rendered.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background