Does 66821 require prior authorization?

No, 66821 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 66821?

Medicare facility rate: $275.22. Non-facility rate: $335.35. Work RVU: 3.33.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.33

Facility

$275.22

Non-Facility

$335.35

Medical record must include the ordering provider's assessment related to the patient's complaint for that visit, relevant medical history, and results of pertinent diagnostic tests or procedures.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.
When an ABN is used, Form CMS-R-131 should be signed by the beneficiary; for claims submitted to the Part A MAC, occurrence code 32 and the ABN date are required.
Claims for capsulotomy within three months of cataract surgery must include clear documentation justifying the need for the procedure (e.g., significant visual debility or listed risk factors).

Posterior capsular opacification (ACO/PCO) after cataract surgery causing significant visual debility is an indication for capsulotomy (YAG laser or discission).
Capsulotomy performed less than 3 months after cataract surgery is covered only when documented indications exist (examples: preoperative uveitis, chronic glaucoma, diabetes mellitus, prolonged pilocarpine use, or significant visual debility).
Repeat capsulotomy on the same eye (during the same or separate episode of care) is covered if the medical record contains a clear rationale and documented indications for the repeat procedure.
Coverage for YAG capsulotomy follows the Local Coverage Determination L37644; see LCD L37644 for specific clinical indications.
Nd:YAG anterior or posterior capsulotomy after cataract extraction is reasonable and medically necessary to remedy functional impairment due to anterior or posterior capsule opacification, to prevent intraocular damage from intraocular lens (IOL) dislocation, or to allow evaluation/treatment of posterior segment pathology.
Patient has decreased ability to perform activities of daily living (e.g., reading, watching television, driving, or meeting occupational/vocational expectations) due to capsule opacification.

AETNA-CPB-0354 — YAG Laser in Ophthalmology and Other Selected Indications

A56493 — Billing and Coding: Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy

A56792 — Billing and Coding: YAG Capsulotomy

A58392 — Billing and Coding: Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza)

L38792 — Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza)

Ask Verity about documentation requirements, denial risks, or coverage in your state.