Does 66830 require prior authorization?

No, 66830 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 66830?

Medicare facility rate: $603.22. Non-facility rate: $603.22. Work RVU: 9.23.

Verity

`66830`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

9.23

Facility

$603.22

Non-Facility

$603.22

Documentation Required

When billing ICD-10 codes H26.211, H26.212, H26.213, H26.221, H26.222, H26.223, H26.231, H26.232, H26.233, E08.36, E09.36, E10.36, E11.36, E13.36, or H28, the ICD-10 code for the underlying condition must be listed and coded first on the claim.
When billing ICD-10 codes H26.31, H26.32, H26.33, or H26.8, the causative agent must be identified on the claim.
Medical record must contain a chief complaint documenting symptoms (e.g., blurred vision, reduced contrast sensitivity, glare) associated with impaired functionality and include the patient's own words where possible.
A unique statement describing the specific symptomatic impairment of visual function that results in inability to perform ADLs must be recorded; optional VF-14 or VF-8R visual activities questionnaires (one per eye) may be used to document this.

Key Coverage Criteria

Cataract surgery is indicated when the patient has a symptomatic visual impairment (e.g., blurred vision, reduced contrast sensitivity, glare) that results in inability to function satisfactorily in Activities of Daily Life (reading, television, driving, vocational/recreational tasks).
Documented best-corrected Snellen visual acuity (distance, and near if primary impairment is near) determined by a careful refraction under standard testing conditions demonstrating that the visual impairment cannot be corrected with a tolerable change to glasses or contact lenses.
Cataract surgery is indicated when there is a degree of lens opacity documented that correlates with the impairment of best-corrected visual acuity and cataract is determined to be the most likely primary cause of visual compromise after full ophthalmic evaluation.
When concomitant ocular disease (e.g., macular degeneration, diabetic retinopathy) may affect vision, surgery is indicated if documentation states cataract significantly contributes to the impairment or that surgery is required to establish clear media for treatment/monitoring of the coexisting condition.
Cataract surgery is indicated when there is documentation that the patient desires surgical correction and that risks, benefits, and alternatives have been explained, including a statement if vision improvement is not expected and the patient understands that.
Use of CPT 66982 (complex cataract surgery) is indicated only when the procedure requires devices or techniques not generally used in routine cataract surgery and the operative note provides clear justification (examples: suturing a posterior chamber IOL due to insufficient capsular support; iris hooks for severe miosis; trypan blue for mature cataract).

9 Active Policies

A59805 — Billing and Coding: Cataract Surgery

J05

L39905 — Cataract Surgery

J05

A57195 — Billing and Coding: Cataract Surgery in Adults

L34203 — Cataract Surgery in Adults

L34413 — Cataract Surgery

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66830