Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA11.054c


Attachment:A

Policy #:MA11.054c

Description:ICD-10 codes

Title:Cataract Surgery


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.



COMPLEX CATARACT SURGERY [CPT 66982 AND 66987] IS MEDICALLY NECESSARY WITH THE FOLLOWING DIAGNOSIS CODES:

E08.36 Diabetes mellitus due to underlying condition with diabetic cataract
E09.36 Drug or chemical induced diabetes mellitus with diabetic cataract
E10.36 Type 1 diabetes mellitus with diabetic cataract
E11.36 Type 2 diabetes mellitus with diabetic cataract
E13.36 Other specified diabetes mellitus with diabetic cataract
H20.20 Lens-induced iridocyclitis, unspecified eye
H20.21 Lens-induced iridocyclitis, right eye
H20.22 Lens-induced iridocyclitis, left eye
H20.23 Lens-induced iridocyclitis, bilateral
H21.221 Degeneration of ciliary body, right eye
H21.222 Degeneration of ciliary body, left eye
H21.223 Degeneration of ciliary body, bilateral
H21.229 Degeneration of ciliary body, unspecified eye
H21.261 Iris atrophy (essential) (progressive), right eye
H21.262 Iris atrophy (essential) (progressive), left eye
H21.263 Iris atrophy (essential) (progressive), bilateral
H21.269 Iris atrophy (essential) (progressive), unspecified eye
H21.271 Miotic pupillary cyst, right eye
H21.272 Miotic pupillary cyst, left eye
H21.273 Miotic pupillary cyst, bilateral
H21.279 Miotic pupillary cyst, unspecified eye
H21.29 Other iris atrophy
H21.531 Iridodialysis, right eye
H21.532 Iridodialysis, left eye
H21.533 Iridodialysis, bilateral
H21.539 Iridodialysis, unspecified eye
H21.561 Pupillary abnormality, right eye
H21.562 Pupillary abnormality, left eye
H21.563 Pupillary abnormality, bilateral
H21.569 Pupillary abnormality, unspecified eye
H21.81 Floppy iris syndrome
H21.89 Other specified disorders of iris and ciliary body
H21.9 Unspecified disorder of iris and ciliary body
H22 Disorders of iris and ciliary body in diseases classified elsewhere
H25.011 Cortical age-related cataract, right eye
H25.012 Cortical age-related cataract, left eye
H25.013 Cortical age-related cataract, bilateral
H25.019 Cortical age-related cataract, unspecified eye
H25.031 Anterior subcapsular polar age-related cataract, right eye
H25.032 Anterior subcapsular polar age-related cataract, left eye
H25.033 Anterior subcapsular polar age-related cataract, bilateral
H25.039 Anterior subcapsular polar age-related cataract, unspecified eye
H25.041 Posterior subcapsular polar age-related cataract, right eye
H25.042 Posterior subcapsular polar age-related cataract, left eye
H25.043 Posterior subcapsular polar age-related cataract, bilateral
H25.049 Posterior subcapsular polar age-related cataract, unspecified eye
H25.10 Age-related nuclear cataract, unspecified eye
H25.11 Age-related nuclear cataract, right eye
H25.12 Age-related nuclear cataract, left eye
H25.13 Age-related nuclear cataract, bilateral
H25.20 Age-related cataract, morgagnian type, unspecified eye
H25.21 Age-related cataract, morgagnian type, right eye
H25.22 Age-related cataract, morgagnian type, left eye
H25.23 Age-related cataract, morgagnian type, bilateral
H25.811 Combined forms of age-related cataract, right eye
H25.812 Combined forms of age-related cataract, left eye
H25.813 Combined forms of age-related cataract, bilateral
H25.819 Combined forms of age-related cataract, unspecified eye
H25.89 Other age-related cataract
H25.9 Unspecified age-related cataract
H26.001 Unspecified infantile and juvenile cataract, right eye
H26.002 Unspecified infantile and juvenile cataract, left eye
H26.003 Unspecified infantile and juvenile cataract, bilateral
H26.009 Unspecified infantile and juvenile cataract, unspecified eye
H26.011 Infantile and juvenile cortical, lamellar, or zonular cataract, right eye
H26.012 Infantile and juvenile cortical, lamellar, or zonular cataract, left eye
H26.013 Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral
H26.019 Infantile and juvenile cortical, lamellar, or zonular cataract, unspecified eye
H26.031 Infantile and juvenile nuclear cataract, right eye
H26.032 Infantile and juvenile nuclear cataract, left eye
H26.033 Infantile and juvenile nuclear cataract, bilateral
H26.039 Infantile and juvenile nuclear cataract, unspecified eye
H26.041 Anterior subcapsular polar infantile and juvenile cataract, right eye
H26.042 Anterior subcapsular polar infantile and juvenile cataract, left eye
H26.043 Anterior subcapsular polar infantile and juvenile cataract, bilateral
H26.049 Anterior subcapsular polar infantile and juvenile cataract, unspecified eye
H26.051 Posterior subcapsular polar infantile and juvenile cataract, right eye
H26.052 Posterior subcapsular polar infantile and juvenile cataract, left eye
H26.053 Posterior subcapsular polar infantile and juvenile cataract, bilateral
H26.059 Posterior subcapsular polar infantile and juvenile cataract, unspecified eye
H26.061 Combined forms of infantile and juvenile cataract, right eye
H26.062 Combined forms of infantile and juvenile cataract, left eye
H26.063 Combined forms of infantile and juvenile cataract, bilateral
H26.069 Combined forms of infantile and juvenile cataract, unspecified eye
H26.09 Other infantile and juvenile cataract
H26.101 Unspecified traumatic cataract, right eye
H26.102 Unspecified traumatic cataract, left eye
H26.103 Unspecified traumatic cataract, bilateral
H26.109 Unspecified traumatic cataract, unspecified eye
H26.111 Localized traumatic opacities, right eye
H26.112 Localized traumatic opacities, left eye
H26.113 Localized traumatic opacities, bilateral
H26.119 Localized traumatic opacities, unspecified eye
H26.121 Partially resolved traumatic cataract, right eye
H26.122 Partially resolved traumatic cataract, left eye
H26.123 Partially resolved traumatic cataract, bilateral
H26.129 Partially resolved traumatic cataract, unspecified eye
H26.131 Total traumatic cataract, right eye
H26.132 Total traumatic cataract, left eye
H26.133 Total traumatic cataract, bilateral
H26.139 Total traumatic cataract, unspecified eye
H26.20 Unspecified complicated cataract
H26.211 Cataract with neovascularization, right eye
H26.212 Cataract with neovascularization, left eye
H26.213 Cataract with neovascularization, bilateral
H26.219 Cataract with neovascularization, unspecified eye
H26.221 Cataract secondary to ocular disorders (degenerative) (inflammatory), right eye
H26.222 Cataract secondary to ocular disorders (degenerative) (inflammatory), left eye
H26.223 Cataract secondary to ocular disorders (degenerative) (inflammatory), bilateral
H26.229 Cataract secondary to ocular disorders (degenerative) (inflammatory), unspecified eye
H26.30 Drug-induced cataract, unspecified eye
H26.31 Drug-induced cataract, right eye
H26.32 Drug-induced cataract, left eye
H26.33 Drug-induced cataract, bilateral
H26.8 Other specified cataract
H27.10 Unspecified dislocation of lens
H27.111 Subluxation of lens, right eye
H27.112 Subluxation of lens, left eye
H27.113 Subluxation of lens, bilateral
H27.119 Subluxation of lens, unspecified eye
H27.121 Anterior dislocation of lens, right eye
H27.122 Anterior dislocation of lens, left eye
H27.123 Anterior dislocation of lens, bilateral
H27.129 Anterior dislocation of lens, unspecified eye
H27.131 Posterior dislocation of lens, right eye
H27.132 Posterior dislocation of lens, left eye
H27.133 Posterior dislocation of lens, bilateral
H27.139 Posterior dislocation of lens, unspecified eye
H28 Cataract in diseases classified elsewhere
H57.00 Unspecified anomaly of pupillary function
H57.01 Argyll Robertson pupil, atypical
H57.02 Anisocoria
H57.03 Miosis
H57.04 Mydriasis
H57.051 Tonic pupil, right eye
H57.052 Tonic pupil, left eye
H57.053 Tonic pupil, bilateral
H57.059 Tonic pupil, unspecified eye
H57.09 Other anomalies of pupillary function
H57.9 Unspecified disorder of eye and adnexa
Q12.0 Congenital cataract
Q12.1 Congenital displaced lens
Q12.2 Coloboma of lens
Q12.4 Spherophakia
Q12.8 Other congenital lens malformations
Q12.9 Congenital lens malformation, unspecified
Q13.0 Coloboma of iris
Q13.1 Absence of iris
Q13.2 Other congenital malformations of iris

CATARACT SURGERY [CPT 66840, 66850, 66852, 66920, 66940, 66983, 66984, 66988] IS MEDICALLY NECESSARY WITH THE FOLLOWING DIAGNOSIS CODES:

E08.36 Diabetes mellitus due to underlying condition with diabetic cataract
E09.36 Drug or chemical induced diabetes mellitus with diabetic cataract
E10.36 Type 1 diabetes mellitus with diabetic cataract
E11.36 Type 2 diabetes mellitus with diabetic cataract
E13.36 Other specified diabetes mellitus with diabetic cataract
H25.011 Cortical age-related cataract, right eye
H25.012 Cortical age-related cataract, left eye
H25.013 Cortical age-related cataract, bilateral
H25.019 Cortical age-related cataract, unspecified eye
H25.031 Anterior subcapsular polar age-related cataract, right eye
H25.032 Anterior subcapsular polar age-related cataract, left eye
H25.033 Anterior subcapsular polar age-related cataract, bilateral
H25.039 Anterior subcapsular polar age-related cataract, unspecified eye
H25.041 Posterior subcapsular polar age-related cataract, right eye
H25.042 Posterior subcapsular polar age-related cataract, left eye
H25.043 Posterior subcapsular polar age-related cataract, bilateral
H25.049 Posterior subcapsular polar age-related cataract, unspecified eye
H25.091 Other age-related incipient cataract, right eye
H25.092 Other age-related incipient cataract, left eye
H25.093 Other age-related incipient cataract, bilateral
H25.099 Other age-related incipient cataract, unspecified eye
H25.10 Age-related nuclear cataract, unspecified eye
H25.11 Age-related nuclear cataract, right eye
H25.12 Age-related nuclear cataract, left eye
H25.13 Age-related nuclear cataract, bilateral
H25.20 Age-related cataract, morgagnian type, unspecified eye
H25.21 Age-related cataract, morgagnian type, right eye
H25.22 Age-related cataract, morgagnian type, left eye
H25.23 Age-related cataract, morgagnian type, bilateral
H25.811 Combined forms of age-related cataract, right eye
H25.812 Combined forms of age-related cataract, left eye
H25.813 Combined forms of age-related cataract, bilateral
H25.819 Combined forms of age-related cataract, unspecified eye
H25.89 Other age-related cataract
H25.9 Unspecified age-related cataract
H26.001 Unspecified infantile and juvenile cataract, right eye
H26.002 Unspecified infantile and juvenile cataract, left eye
H26.003 Unspecified infantile and juvenile cataract, bilateral
H26.009 Unspecified infantile and juvenile cataract, unspecified eye
H26.011 Infantile and juvenile cortical, lamellar, or zonular cataract, right eye
H26.012 Infantile and juvenile cortical, lamellar, or zonular cataract, left eye
H26.013 Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral
H26.019 Infantile and juvenile cortical, lamellar, or zonular cataract, unspecified eye
H26.031 Infantile and juvenile nuclear cataract, right eye
H26.032 Infantile and juvenile nuclear cataract, left eye
H26.033 Infantile and juvenile nuclear cataract, bilateral
H26.039 Infantile and juvenile nuclear cataract, unspecified eye
H26.041 Anterior subcapsular polar infantile and juvenile cataract, right eye
H26.042 Anterior subcapsular polar infantile and juvenile cataract, left eye
H26.043 Anterior subcapsular polar infantile and juvenile cataract, bilateral
H26.049 Anterior subcapsular polar infantile and juvenile cataract, unspecified eye
H26.051 Posterior subcapsular polar infantile and juvenile cataract, right eye
H26.052 Posterior subcapsular polar infantile and juvenile cataract, left eye
H26.053 Posterior subcapsular polar infantile and juvenile cataract, bilateral
H26.059 Posterior subcapsular polar infantile and juvenile cataract, unspecified eye
H26.061 Combined forms of infantile and juvenile cataract, right eye
H26.062 Combined forms of infantile and juvenile cataract, left eye
H26.063 Combined forms of infantile and juvenile cataract, bilateral
H26.069 Combined forms of infantile and juvenile cataract, unspecified eye
H26.09 Other infantile and juvenile cataract
H26.101 Unspecified traumatic cataract, right eye
H26.102 Unspecified traumatic cataract, left eye
H26.103 Unspecified traumatic cataract, bilateral
H26.109 Unspecified traumatic cataract, unspecified eye
H26.111 Localized traumatic opacities, right eye
H26.112 Localized traumatic opacities, left eye
H26.113 Localized traumatic opacities, bilateral
H26.119 Localized traumatic opacities, unspecified eye
H26.121 Partially resolved traumatic cataract, right eye
H26.122 Partially resolved traumatic cataract, left eye
H26.123 Partially resolved traumatic cataract, bilateral
H26.129 Partially resolved traumatic cataract, unspecified eye
H26.131 Total traumatic cataract, right eye
H26.132 Total traumatic cataract, left eye
H26.133 Total traumatic cataract, bilateral
H26.139 Total traumatic cataract, unspecified eye
H26.20 Unspecified complicated cataract
H26.211 Cataract with neovascularization, right eye
H26.212 Cataract with neovascularization, left eye
H26.213 Cataract with neovascularization, bilateral
H26.219 Cataract with neovascularization, unspecified eye
H26.221 Cataract secondary to ocular disorders (degenerative) (inflammatory), right eye
H26.222 Cataract secondary to ocular disorders (degenerative) (inflammatory), left eye
H26.223 Cataract secondary to ocular disorders (degenerative) (inflammatory), bilateral
H26.229 Cataract secondary to ocular disorders (degenerative) (inflammatory), unspecified eye
H26.231 Glaucomatous flecks (subcapsular), right eye
H26.232 Glaucomatous flecks (subcapsular), left eye
H26.233 Glaucomatous flecks (subcapsular), bilateral
H26.239 Glaucomatous flecks (subcapsular), unspecified eye
H26.30 Drug-induced cataract, unspecified eye
H26.31 Drug-induced cataract, right eye
H26.32 Drug-induced cataract, left eye
H26.33 Drug-induced cataract, bilateral
H26.40 Unspecified secondary cataract
H26.411 Soemmering's ring, right eye
H26.412 Soemmering's ring, left eye
H26.413 Soemmering's ring, bilateral
H26.419 Soemmering's ring, unspecified eye
H26.491 Other secondary cataract, right eye
H26.492 Other secondary cataract, left eye
H26.493 Other secondary cataract, bilateral
H26.499 Other secondary cataract, unspecified eye
H26.8 Other specified cataract
H26.9 Unspecified cataract
H28 Cataract in diseases classified elsewhere
H40.89 Other specified glaucoma
H53.2 Diplopia
H59.021 Cataract (lens) fragments in eye following cataract surgery, right eye
H59.022 Cataract (lens) fragments in eye following cataract surgery, left eye
H59.023 Cataract (lens) fragments in eye following cataract surgery, bilateral
H59.029 Cataract (lens) fragments in eye following cataract surgery, unspecified eye

Version Effective Date: 01/01/2020
Version Issued Date: 01/03/2020
Version Reissued Date: N/A

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