Complex cataract code added to ASC list

WASHINGTON — Following months of discussions with the American Academy of Ophthalmology and others, the Health Care Financing Administration (HCFA) has agreed to add 66982, the new current procedure terminology (CPT) code for complex cataract surgery, to the list of services eligible for payment to ambulatory surgery centers (ASCs). HCFA was already paying surgeons for this type of procedure. HCFA is the federal agency that administers Medicare, Medicaid and the State Children's Health Insurance Program.

The Academy worked to have the new CPT code created to recognize the increasing number of patients needing more complicated treatment. HCFA already was paying ASCs for cataract surgery, but did not include the new code on the list of procedures when it began reimbursing physicians for complex cataract surgery on January 1, 2001.

“The addition of this code on the ASC payment list expands the opportunity for eye physicians to perform this procedure since facility payment for the procedure no longer is limited to hospital-based entities,” said Catherine Cohen, Academy VP for governmental affairs. “Prior to this addition, ophthalmologists performing cataract surgery in ASCs could be paid for their work, but the ASCs could not.” This update to the ASC list will be effective July 1 and retroactive to January 1, 2001.

Only payments to the facilities will change. Beginning July 1, ASCs can submit claims for all complex cataract surgery that ophthalmologists might have performed in their facilities since January 1, 2001. Claims submitted by facilities for 66982 (complex cataract) will be paid at the same rate as for the base cataract code—66984 (ASC Group 8, which is $750 + $150 for the intraocular lens). CPT code 66982 is only to be used for patients who present certain challenges, such as bound-down pupils, noted the Academy. The determinations must be made prior to surgery and may not be used for complications that may arise during the surgery.