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Medicare Reimbursement for YAG Laser Capsulotomy

Topic: YAG Capsulotomy

Sponsor: Corcoran Consulting Group

Updated: 01/24/2020

Corcoran Consulting Group

During extracapsular cataract surgery, the posterior shell of the lens is preserved. If the posterior capsule later develops opacities that reduce visual acuity, a YAG laser is used to cut the capsule and/or the adjacent hyaloid membrane to restore clear vision. For some patients, multiple sessions may be needed to create an adequate opening in the lens capsule.

This FAQ addresses the following:

  1. What is a YAG laser capsulotomy?
  2. What are the indications for this procedure?
  3. What CPT code describes a YAG laser capsulotomy?
  4. What diagnoses support a claim for YAG laser capsulotomy?
  5. How should this procedure be documented in the medical record?
  6. How much does Medicare reimburse for 66821?
  7. Are repeat YAG procedures during the global surgery period covered?
  8. What is the frequency of YAG laser capsulotomy after cataract surgery?
  9. Is reimbursement made for YAG capsulotomy performed in the global surgery period of cataract?
  10. May 66821 be used to report YAG laser of the anterior capsule or to remove specks from the surface of the IOL?