Cataract Surgery price: Medicare anchor and facility lever

What this procedure is, in price terms

Cataract Surgery is billed under CPT 66984: Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (for example irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation The code, not the marketing name, determines the Medicare anchor and the cash quote. If the order changes - for example with contrast instead of without, or a biopsy is added - the code changes and the price changes with it. Ask the ordering clinician's office to confirm the expected code before you price-shop, and ask the facility what code will be billed if the plan changes on the day.

What the price includes

• Surgeon professional fee for cataract removal with standard lens insertion (PFS anchor below)
• Operating room and standard lens cost inside the facility payment

What the price usually excludes

• Anesthesia billed separately
• Premium intraocular lens upgrades and related testing billed under separate lines
• Pre-operative visits outside the surgical package and post-operative care transferred to another clinician
• The second eye billed as a separate procedure on a later date

A quote is complete only when it states which of the excluded items apply to you and what each costs. Get that in writing.

Why prices vary for CPT 66984

For cataract surgery the surgeon professional anchor is the same in a hospital and an ASC. The facility layer is what moves: a hospital comprehensive APC versus an ASC facility fee at a lower rate for the same code. Anesthesia bills separately in both settings. An all-in written quote should list surgeon, facility, and anesthesia lines.

Geography also matters. Physician Fee Schedule amounts are locality-adjusted, so the Michigan Locality 01 anchor on this page will differ somewhat from the amount in another locality. OPPS amounts are national unadjusted rates before the hospital wage index is applied. Use the anchor for order of magnitude and for the facility comparison, not as a prediction of your bill.

The facility-type lever

Ask whether surgery will be at a hospital outpatient department or an ASC, and get the facility fee, surgeon fee, and anesthesia fee as separate written lines for CPT 66984.

Compare the same CPT code in more than one setting when your clinician allows a choice:

• Hospital Outpatient Department - OPPS (APC-based facility payment) + Physician Fee Schedule professional fee. Facility fee: Yes - separate OPPS facility payment to the hospital.
• Ambulatory Surgery Center - ASC payment system (procedure-based, generally below OPPS) + Physician Fee Schedule professional fee. Facility fee: Yes - ASC facility fee, typically lower than hospital OPPS for the same procedure.
• Independent Imaging Center - Physician Fee Schedule global payment when the center owns the equipment and employs or contracts the radiologist. Facility fee: No separate hospital facility fee - the technical component is inside the global PFS payment.
• Physician Office - Physician Fee Schedule nonfacility payment (higher practice-expense component than facility rate). Facility fee: No separate facility fee - office overhead is inside the nonfacility PFS rate.

Use the Price Anchor Explorer to see how the anchor presentation changes by facility type.

Self-pay ranges on this page

Self-pay ranges are not published yet for Cataract Surgery. MyCarePrice adds a self-pay range only where it can be verified from a public source under Procedure Price Method v1.0. Until then, this page ships the verified Medicare anchor plus facility-type education. That is deliberate: an invented range would be worse than no range.

To get a real self-pay number today, ask the facility directly: "What is the all-in cash price for CPT 66984, including professional, facility, anesthesia, and pathology if they apply?" See How to ask for the cash price and Questions to ask billing before your procedure.

Questions to ask before you book

1. What CPT code will be billed if nothing changes, and what code will be billed if the plan changes?
2. Is the quote global, or will the professional fee bill separately?
3. What setting is this price for, and what would the same code cost in the other setting you offer?
4. Are anesthesia and pathology included, likely, or billed separately?
5. Can I have the all-in price in writing, with the code, setting, and inclusions listed?

Frequently asked questions

Sources and verification