Cataract surgery billing
Bill for Priority Health Medicare patients according to Medicare rules.
Ophthalmologist billing for cataract surgery & services
- Ophthalmologists who perform cataract surgery intraoperative and postoperative services should bill the global surgery code without any modifiers.
- Modifiers 54, 55 and 56 should only be billed on cataract surgery codes when two ophthalmologists are performing the surgery-related services. Each will be paid according to the global split percentages for preoperative, intraoperative and postoperative care.
Optometrist billing for post-surgical co-management services
Priority Health reimburses optometrists for co-management services following cataract surgery for all products.
Affected CPT codes:
66820, 66821, 66852, and 66983-66985
Surgical services, modifier 54
- Report surgical services with the CPT code for the cataract surgery and the 54 modifier to indicate that only the surgical component of the global surgical package was provided.
- Claim will be reimbursed at the appropriate percentage of the fee schedule for surgical services.
Post-operative services, modifier 55
- Report any post-operative service with the CPT code for the cataract surgery and the 55 modifier to indicate that you perfomed only post-operative services.
- List the exact dates you performed post-operative care in the notes section of the claim so we can reimburse surgical and post-operative services rendered by each provider.
- Claim will be reimbursed at the appropriate percentage of the fee schedule for post-operative care.