CPT Code 66984

CPT code 66984 is for cataract extraction without an intraocular lens implant.

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What is CPT Code 66984

CPT code 66984 is used to denote a medical procedure involving the removal of a cataract with the insertion of an intraocular lens. This code specifies that the cataract extraction is performed using a technique called phacoemulsification, which involves the use of ultrasonic energy to break up and remove the cataract, followed by the placement of an artificial lens within the same surgical session, without the use of an endoscopic approach.

Does CPT 66984 Need a Modifier?

For CPT code 66984, which pertains to cataract extraction (phacoemulsification) with intraocular lens (IOL) implantation, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here’s an ordered list of relevant modifiers and the reasons for their use:

1. -LT and -RT
- Reason: These modifiers indicate that the service was performed on the left side (-LT) or the right side (-RT) of the body. Since eye procedures are specific to each eye, using these modifiers specifies which eye underwent the procedure.

2. -50
- Reason: This modifier is used for procedures that are performed bilaterally. If the cataract extraction was performed on both eyes during the same operative session, this modifier would be appropriate.

3. -51
- Reason: This modifier indicates that multiple procedures were performed during the same surgical session. It might be used if another distinct procedure, apart from 66984, was performed during the same session.

4. -54
- Reason: Indicates that only the surgical care was provided by the performing physician. This might be used if postoperative management is being handled by another provider.

5. -55
- Reason: Used when the provider is only responsible for the postoperative management of the patient. This would apply if another physician performed the surgery and the billing provider is only handling the postoperative care.

6. -56
- Reason: Indicates that the provider performed the preoperative management but did not perform the surgery. This modifier is less commonly used but applicable in coordinated care scenarios.

7. -24
- Reason: Used to describe an unrelated evaluation and management service by the same physician during a postoperative period. If the patient is seen for an unrelated issue during the postoperative period of the cataract surgery, this modifier would be necessary.

8. -79
- Reason: Applicable when an unrelated procedure or service is performed by the same physician during the postoperative period of the original procedure. If another unrelated eye procedure is needed during the recovery phase of the cataract surgery, this modifier would be used.

Each of these modifiers serves to provide clear, specific information to payers about the circumstances under which the procedure was performed and who was responsible for various aspects of patient care, which is crucial for appropriate reimbursement.

CPT Code 66984 Medicare Reimbursement

CPT code 66984, which refers to cataract extraction (phacoemulsification) with intraocular lens (IOL) implantation, is reimbursed by Medicare. The reimbursement for this procedure can vary based on geographic location, the setting in which the procedure is performed (hospital outpatient department vs. ambulatory surgical center), and other factors. Generally, the Medicare Physician Fee Schedule (MPFS) provides specific reimbursement rates for this code.

As of the most recent data, the national average Medicare payment for CPT code 66984 when performed in an ambulatory surgical center is approximately $976, and when performed in a hospital outpatient setting, it is approximately $1,683. These amounts are subject to change annually based on updates to the MPFS and adjustments for specific geographic practice cost indices.

Healthcare providers should verify the current reimbursement rates through the Medicare Administrative Contractor (MAC) that services their geographic area or consult the latest MPFS for the most accurate and up-to-date information.

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