Prior Authorization
Aetna Prior Authorization for CPT 66984
Site of service - Cataract surgery (outpatient hospital only) · Standard commercial plans
Source
Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Aetna requires precertification for cataract extraction with IOL insertion. Visual acuity 20/50 or worse with best correction, or cataract causing functional limitation (glare disability, impaired night driving). Documentation must include slit-lamp exam with cataract grading and refraction. Bilateral same-day surgery generally not approved unless medical justification provided.
Documentation checklist
- ✓Comprehensive dilated eye exam with best-corrected visual acuity
- ✓Slit-lamp examination documenting cataract type and grade
- ✓Refraction results
- ✓IOL biometry/calculation
Submission channels
Phone
1-800-624-0756Fax
1-860-754-56702026 Medicare rate for CPT 66984
Office (non-facility)
$462.60
Facility
$462.60
Total RVUs (office)
13.85
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Aetna's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 66984 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Comprehensive dilated eye exam with best-corrected visual acuity, Slit-lamp examination documenting cataract type and grade, Refraction results….
- 3Submit via phone or fax, or the payer portal.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Aetna require prior authorization for CPT 66984?
- Yes. Aetna requires prior authorization for CPT 66984 (Site of service - Cataract surgery (outpatient hospital only)) under Standard commercial plans per its published clinical policy.
- What documentation does Aetna require for CPT 66984?
- Comprehensive dilated eye exam with best-corrected visual acuity; Slit-lamp examination documenting cataract type and grade; Refraction results; IOL biometry/calculation
- How much does Medicare pay for CPT 66984 in 2026?
- In 2026, the national Medicare allowable for CPT 66984 is $462.60 in an office setting and $462.60 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.
- What if Aetna denies the PA for CPT 66984?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Aetna PA lookups
CPT 66984 prior authorization by payer
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