CMS Pub. 100-04, ch. 32, § 120.2

Physicians and hospitals must report one of the following Current Procedural Terminology (CPT) codes on

the claim:

66982 - Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage

procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex

requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device,

suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the

amblyogenic development stage.

• 66983 - Intracapsular cataract with insertion of intraocular lens prosthesis (one stage procedure)

• 66984 - Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage

procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification)

• 66985 - Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent

cataract extraction

• 66986 - Exchange of intraocular lens

In addition, physicians inserting a P-C IOL or A-C IOL in an office setting may bill code V2632 (posterior

chamber intraocular lens) for the IOL. Medicare will make payment for the lens based on reasonable cost for a

conventional IOL. Place of Service (POS) = 11.

Effective for dates of service on and after January 1, 2006, physician, hospitals and ASCs may also bill the

non-covered charges related to the P-C function of the IOL using HCPCS code V2788. Effective for dates of

service on and after January 22, 2007 through January 1, 2008, non-covered charges related to A-C function

of the IOL can be billed using HCPCS code V2788. The type of service indicator for the non-covered billed

charges is Q. (The type of service is applied by the Medicare carrier and not the provider). Effective for A-C

IOL insertion services on or after January 1, 2008, physicians, hospitals and ASCs should use V2787 rather

than V2788 to report any additional charges that accrue.

When denying the non-payable charges submitted with V2787 or V2788, contractors shall use an appropriate

Medical Summary Notice (MSN) such as 16.10 (Medicare does not pay for this item or service) and an

appropriate claim adjustment reason code such as 96 (non-covered charges) for claims submitted with the

non-payable charges.

Hospitals and physicians may use the proper CPT code(s) to bill Medicare for evaluation and management

services usually associated with services following cataract extraction surgery, if appropriate.

A - Applicable Bill Types

The hospital applicable bill types are 12X, 13X, 83X and 85X.

B - Other Special Requirements for Hospitals

Hospitals shall continue to pay CAHs method 2 claims under current payment methodologies for conditional

IOLs.