Does 66988 require prior authorization?

No, 66988 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 66988?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Both the surgical-care claim and postoperative-management claim(s) must include the same date of service, the same surgical procedure code, and the appropriate CPT modifier (54 or 55).
Surgeon and postoperative-care physician must collaborate and document the agreed transfer of care and the chosen date of service/surgical code used for claims submission.
Follow CMS guidance in the Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 12, Sections 40.2-40.4, for additional documentation and billing rules on global surgery and transfer of care.
The medical record must document relevant medical history, physical exam, and results of pertinent diagnostic tests or procedures sufficient to support medical necessity for the cataract extraction.

When physicians agree to transfer care during the global surgery period, submit the surgical-care claim with CPT modifier 54 (surgical care only).
When physicians agree to transfer care during the global surgery period, submit the postoperative-management claim with CPT modifier 55 (postoperative management only).
The surgical-care claim and the postoperative-management claim(s) must contain the same date of service and the same surgical procedure code and be distinguished only by the appropriate modifier (54 or 55).
Cataract extraction is covered when necessary to provide an unimpeded view of the fundus to allow proper management of posterior segment disease, with the cataract diagnosis billed as primary and the posterior segment disease as secondary.
Cataract extraction is covered for anisometropia when there is significant aniseikonia secondary to a prior cataract extraction with IOL implant and the aniseikonia is visually significant to the patient.
Complex cataract extraction (CPT 66982 and 66987) is covered when the procedure requires devices or techniques not generally used in routine cataract surgery (e.g., capsular support devices, permanent intraocular sutures, extensive iris maneuvers, prosthetic iris placement, primary posterior capsulorhexis, treatment of phacolytic glaucoma, or other extraordinary operative/postoperative work).

L39905 — Cataract Surgery

J05

A59805 — Billing and Coding: Cataract Surgery

J05

A56544 — Billing and Coding: Cataract Extraction

J06

L33558 — Cataract Extraction

J06

A58592 — Billing and Coding: Cataract Extraction (including Complex Cataract Surgery)

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