Cataract Extraction

Medicare covers cataract extraction (with or without intraocular lens) when a beneficiary has cataract-related visual impairment that limits activities of daily living and meets objective criteria (e.g., best corrected visual acuity 20/50 or worse, or documented two-line acuity decline on consensual light or glare testing), other ocular causes have been ruled out, significant improvement is expected, and required preoperative evaluation and patient education are documented. Complex cases (CPT 66982), vitrectomy-associated extractions, and immediate sequential bilateral surgery are allowable when specific intraoperative/postoperative circumstances and detailed documentation (including justification and applicable diagnosis codes) are present; routine extraction for BCVA better than 20/40 is not routinely covered absent substantial documented medical necessity.

"Patient has a cataract causing impairment of visual function with decreased ability to perform activities of daily living (e."