NOV 06, 2019
Billing Cataract Surgery in Conjunction With iStent Inject
Question: When our surgeon performs cataract surgery plus iStent inject on a Medicare Part B patient, how should the surgeon and the facility submit the claim?
Answer: The surgeon and facility claim should match. Not having the claims match may trigger an unnecessary audit.
For the surgeon: Submit 66984, or if the surgery meets the criteria for complex cataract surgery, submit 66982 plus 0191T plus 0376T.
Be sure to link the cataract diagnosis to 66984/66982 and the glaucoma diagnosis to 0191T and 0376T.
Payment to the surgeon will be 100% of the allowable for 66984 or 66982 plus 100% of 0191T (allowables range from $162 to $876). Some Medicare Administrative Contractors (MACs) have an allowable for 0376T as well, which will also pay at 100% of the fee schedule. For those MACs that don't provide coverage for 0376T, the surgeon may charge a reasonable fee to the patient. Note: Multiple Procedure Payment Reduction (MPPR) does not impact physician payment for Category III CPT codes.
For the facility: Submit 66984 or 66982 to match the surgeon, plus 0191T and 0376T.
Payment to the facility will be 100% of the allowable for 0191T, plus 50% of the allowable for 66984 or 66982. Due to the packaged status of 0376T, the ambulatory surgery center (ASC) will not receive payment for 0376T from the payer and cannot bill the patient, but should submit the code to the payer as a tracking code to report utilization.
Physicians should consult with their MAC for current coverage and payment positions. Commercial plans will vary.
Learn more in Learn to Code Glaucoma.