Does 66989 require prior authorization?

No, 66989 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 66989?

Medicare facility rate: $718.79. Non-facility rate: $718.79. Work RVU: 11.83.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

11.83

Facility

$718.79

Non-Facility

$718.79

The medical record must support medical necessity for the service and include prior glaucoma treatments and the patient's response to those treatments.
Every page of the record must be legible and include appropriate patient identification (e.g., full name, dates of service) and the legible signature of the physician or non-physician practitioner providing care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Use specified claim fields for billing: Part A — Line SV202-7 for 837I or Block 80 for UB-04; Part B — Loop 2400 or SV101-7 for 837P or Box 19 for paper claims.

CPT 66991 may be reported for noncomplex cataract removal with intraocular lens (IOL) implant performed with concomitant intraocular aqueous drainage device insertion (e.g., iStent) when the medically reasonable and necessary criteria in the related LCD are met.
CPT 66989 may be reported for complex cataract removal with IOL implant performed with concomitant intraocular aqueous drainage device insertion when the medically reasonable and necessary criteria in the related LCD are met.
CPT 65820 may be reported for true goniotomy defined as incision and/or excision of trabecular meshwork for at least three clock hours via an internal approach to create an opening into Schlemm canal, reported per eye.
Use unlisted CPT 66999 for goniopuncture or microgoniotomy procedures when no specific CPT code exists and identify the procedure in the narrative.
CPT 0449T or 0671T may be reported for insertion of glaucoma drainage device(s) into the subconjunctival space (e.g., XEN45, iStent Infinite) when the medically reasonable and necessary criteria in the related LCD are met.
Phacoemulsification with IOL placement may be performed together with a single MIGS procedure during the same operative session in the same eye.

A59805 — Billing and Coding: Cataract Surgery

J05

L39905 — Cataract Surgery

J05

L39907 — Micro-Invasive Glaucoma Surgery (MIGS)

J05

A59807 — Billing and Coding: Micro-Invasive Glaucoma Surgery

J05

L37244 — Micro-Invasive Glaucoma Surgery (MIGS)

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