Prior Authorization
Anthem Prior Authorization for CPT 66984
Site of service - Cataract surgery (outpatient hospital only) · Standard commercial plans
Source
Anthem clinical policyNot 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
Anthem requires prior authorization for cataract surgery via AIM Specialty Health. Criteria: BCVA 20/50 or worse in operative eye, or documented functional impairment from cataract-induced glare or reduced contrast. Slit-lamp documentation of cataract type and density required. Premium IOL upgrades (toric, multifocal) not included in standard authorization.
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
1-800-274-77672026 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). Anthem'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 the payer portal.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Anthem require prior authorization for CPT 66984?
- Yes. Anthem 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 Anthem 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 Anthem are typically negotiated against this benchmark.
- What if Anthem 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 Anthem PA lookups
CPT 66984 prior authorization by payer
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