Ophthalmology is one of the procedural specialties hit by the 2026 facility-based practice expense cuts under CMS-1832-F, particularly on retinal surgery performed in hospital outpatient settings. The 2026 CPT code set retained the cataract codes (66982 for complex, 66984 for routine) with documentation refinements, the retinal surgery codes (67005-67043), and the glaucoma surgery codes (66170-66185). For ophthalmology practices, the 2026 billing playbook is built around three things: capturing complexity for cataract billing, retina-specific intraoperative coding, and global period management on multi-stage glaucoma procedures.
Cataract surgery: 66982 versus 66984
The CPT distinction between complex cataract surgery (66982) and routine cataract surgery (66984) drives meaningful reimbursement differences and is one of the most-audited code pair selections in ophthalmology. Complex cataract surgery (66982) requires devices or techniques not generally used in routine cataract surgery, performed because of the patient’s specific anatomic or pathologic findings. Common qualifying findings include miotic pupils requiring iris expansion, weak zonules requiring capsular tension ring, mature white cataracts, and patients with Flomax-induced floppy iris syndrome. The documentation must establish the specific finding and the specific intervention; “difficult case” without further detail does not support 66982.
Documenting complexity for 66982
Audit-defensible 66982 documentation includes the preoperative finding (miotic pupil, weak zonules, mature lens, dense brunescent cataract, prior trauma), the specific intervention performed (iris hooks, Malyugin ring, capsular tension ring, capsular dye), and the rationale tying the intervention to the finding. Practices that bill 66982 routinely on a high percentage of cataract cases without this documentation invite focused review. Practices that bill 66982 selectively, with documentation that establishes the qualifying anatomy, capture the higher reimbursement on the cases that warrant it without exposing the rest of the cataract panel.
Retinal surgery codes
Retinal surgery codes (67005-67043) cover vitrectomy and related procedures, with codes selected by extent of vitrectomy, removal of foreign body, and any add-on procedures performed. Vitrectomy with membrane peeling (67042), vitrectomy with epiretinal membrane stripping (67041), and vitrectomy with focal endolaser photocoagulation (67039) each require specific documentation of the work performed. The most common audit failure on retinal surgery is bundled add-on codes (67039, 67040, 67041, 67042, 67043) billed without documentation that establishes each was a distinct procedure during the same vitrectomy operation.
Intravitreal injection (67028) bundling
Intravitreal injection of pharmacologic agent (67028) is a high-volume code in retinal practice for anti-VEGF therapy. The injection itself is billed alongside the J-code for the drug (J0178 for aflibercept, J2778 for ranibizumab, J9035 for bevacizumab when used off-label). The most common billing error is missing the J-code or billing the wrong J-code for the formulation used. Documentation must include the drug, dose, lot number, eye injected, and the indication. NCCI edits prevent bundling 67028 with an exam code on the same day in some scenarios; modifier 25 may be required when a separate E/M service is performed and documented.
Glaucoma surgery and the global period
Trabeculectomy (66170, 66172) and aqueous shunt procedures (66180, 66185) carry 90-day global periods. Postoperative visits during the global period are not separately billable unless they address an unrelated problem, in which case modifier 24 applies. Multi-stage glaucoma procedures (initial surgery followed by needling or revision) require careful global period tracking, because revisions performed within the global period of the initial surgery may need modifier 78 (related procedure during postoperative period) or modifier 79 (unrelated procedure during postoperative period). Practices that track global periods at the patient level avoid both denied claims and audit findings on bundled services billed separately.
Diagnostic testing
Ophthalmology diagnostic testing has its own audit profile. Optical coherence tomography (92133 for posterior segment, 92134 for retinal) is high-volume and high-error when frequency rules are not followed. Visual field testing (92081, 92082, 92083) requires documentation of the specific test performed and the clinical indication. Fluorescein angiography (92235 unilateral, 92236 bilateral) is bundled with certain other services and requires specific documentation of indication. Practices that bill diagnostic testing at every visit by default see denials when frequency rules apply.
How MHB helps ophthalmology practices
For ophthalmology practices that want specialty-trained coders working cataract complexity selection, retinal surgery add-on coding, intravitreal injection workflows, and global period tracking, our team supports specialty medical coding for ophthalmology.
The bottom line
Ophthalmology billing in 2026 demands precision on cataract complexity selection, retinal procedure coding, intravitreal injection workflow, and global period management. Practices that build documentation to the standard capture full reimbursement on the work they actually do. Practices that default to routine codes leave money on the table on every complex case and absorb audit risk on the routine ones.
Authoritative sources
This article cites the following primary sources for billing-code and regulatory guidance. Always confirm current rules and codes with the publishing authority before applying to a specific claim.
