Billing code 66820: Secondary cataractMedicare rate & RVUs in Illinois
Report 66820 when an ophthalmologist mechanically opens an opacified capsule or related membrane after cataract surgery rather than using laser treatment.
CMS doesn’t publish an office rate for 66820 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 66820 covers
This procedure creates an opening in a cloudy membrane left behind after cataract surgery, typically the opacified posterior capsule. An ophthalmologist performs the surgical treatment with an instrument rather than a laser. It is used when the membrane interferes with vision and the surgeon chooses a mechanical approach; it is distinct from laser treatment of the same problem and from procedures that remove lens material or reposition an intraocular lens.
Report 66820 for the surgical membrane-opening service, supported by documentation of the secondary opacity, its clinical significance, and the technique performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 66820 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $436.05 |
| East St. Louis | Unavailable | $408.54 |
| Rest Of Illinois | Unavailable | $402.20 |
| Suburban Chicago | Unavailable | $437.16 |
How the 66820 rate is calculated
Each of 66820’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 66820
RVUs × geographic indexes × conversion factor
Work3.91
3.91 RVUs× 1.000 GPCI
Practice expense8.41
8.41 RVUs× 1.000 GPCI
Malpractice0.29
0.29 RVUs× 1.000 GPCI
Adjusted RVUs
12.6100
Conversion factor
$33.4009
Medicare rate
$421.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 66820
66820 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 66820
Secondary cataract
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 66820
Secondary cataract
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
66820 without 50 · national facility
$421.19
Secondary cataract
66820-50 · Bilateral: 150%
$631.79
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
66820 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 66821YAG laser capsulotomy
- Choose 66820 for a mechanical surgical opening of the secondary membrane; choose 66821 when the treatment is performed with laser.
- 66830Lens lesion removal
- 66820 opens the membrane, while 66830 represents removal of the secondary membrane. Follow the operative technique documented.
- 66825Lens repositioning
- 66825 is for repositioning a displaced intraocular lens, not for opening an opacified capsule.
66820 billing questions
How does 66820 differ from 66821?
66820 is for a surgical, mechanical opening of the secondary membrane. Use 66821 when the surgeon treats it with laser.
When is 66830 a better fit?
66830 describes removal of a secondary membrane rather than creating an opening in it. The operative report should support the actual technique and work performed.
Does the 90-day global period include postoperative care?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
Can 66820 be reported bilaterally?
CMS identifies this as a bilateral procedure; reporting modifier 50 is paid at 150%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is restricted. Co-surgeons and team surgery are not permitted for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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