Cataract surgery is the most commonly performed procedure in the United States, with roughly 4 million operations per year. The billing code is CPT 66984 for a standard extracapsular cataract removal with insertion of an intraocular lens (IOL). The cost swings dramatically based on one factor most patients never think to ask about: where the surgery happens.
Quick Answer: Standard cataract surgery (CPT 66984) costs $384 to $598 per eye out-of-pocket for Medicare patients in 2026, after the $283 Part B deductible. At an ambulatory surgery center (ASC), you pay closer to $384. At a hospital outpatient department (HOPD), you pay closer to $598, because the Medicare-approved amount is about 58% higher. Without insurance, expect $3,500 to $7,000 per eye.
The ASC vs. hospital gap is not a minor rounding difference. Medicare data shows the national average facility payment is roughly $976 at an ASC versus $1,683 at a hospital outpatient department for the same CPT 66984 procedure. That $700 difference flows directly into your 20% coinsurance. If your surgeon has privileges at both settings, asking to schedule at the ASC can save you real money.
What CPT 66984 Actually Covers
CPT 66984 describes "extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage), manual or mechanical technique." In plain language, the surgeon removes your clouded natural lens and replaces it with an artificial intraocular lens (IOL) in a single visit.
The procedure takes about 15 to 30 minutes per eye. Surgeons typically do one eye at a time, with a few weeks between sessions. Under Medicare billing, the procedure splits into three separate bills:
- Facility fee (CPT 66984): Covers the operating room, nursing staff, equipment, and the standard monofocal IOL
- Surgeon fee: Billed separately under the physician fee schedule
- Anesthesia fee: Usually a nurse anesthetist or anesthesiologist, billed by time units
All three fees are subject to Medicare Part B rules: 80% covered after you meet the annual deductible, 20% is your coinsurance.
2026 Medicare Payment Rates by Setting
The 2026 final rule updated ASC payment rates by 2.6% over 2025. Here is how the numbers break down for CPT 66984:
| Setting | Medicare-Approved Amount | Medicare Pays (80%) | Patient Pays (20%) |
|---|
| Ambulatory Surgery Center (ASC) | ~$1,920 | ~$1,536 | ~$384 |
| Hospital Outpatient Dept (HOPD) | ~$2,990 | ~$2,392 | ~$598 |
| Difference | ~$1,070 more at HOPD | n/a | ~$214 more per eye |
Amounts shown per eye after the $283 Part B annual deductible is met. Source: Medicare Procedure Price Lookup and CMS 2026 ASC Final Rule.
If you need both eyes done in the same calendar year and you have not met your deductible yet, add $283 to your first procedure cost.
Medigap and Medicare Advantage: If you have a Medigap supplement plan (Plans C, D, F, G, N), it typically pays the 20% coinsurance for you, bringing your out-of-pocket to near zero beyond your monthly premium. Medicare Advantage plans vary widely. Some have $0 copays for surgery at in-network ASCs, while others apply a separate facility copay that can run $200 to $500 per eye.
Why Does the Hospital Cost More for the Same Surgery?
The same CPT code, the same surgeon, the same 20-minute procedure. Yet Medicare pays the hospital roughly $700 more per eye. How?
HOPDs operate under the Outpatient Prospective Payment System (OPPS), a separate rate schedule from the ASC fee schedule. Congress has historically set HOPD rates higher to account for hospitals having heavier overhead: 24/7 emergency departments, teaching programs, uncompensated care pools. ASCs are lean, single-purpose facilities.
The practical result: if a large hospital system buys a local eye surgery practice and converts it to a hospital outpatient department, the exact same procedure in the same building can jump 58% in cost overnight. This "site-of-service" pricing has been scrutinized by CMS for years, and a 2023 Becker's ASC report found HOPDs charge up to 58% more than ASCs across outpatient procedures.
For patients, this matters because:
- You pay 20% of whichever approved amount applies to your setting
- Your Medigap or secondary insurer calculates cost-sharing off the same approved amount
- If you are uninsured or self-pay, the hospital's chargemaster rate (before any discount) is usually 3 to 5 times the Medicare-approved amount
Cost Without Insurance (Self-Pay)
Without any coverage, cataract surgery costs are set by the facility and surgeon, not by Medicare rates. National averages in 2026:
| What You Pay For | Low End | High End |
|---|
| Standard cataract surgery, ASC, basic monofocal IOL | $3,500/eye | $5,000/eye |
| Standard cataract surgery, hospital, basic monofocal IOL | $4,500/eye | $7,000/eye |
| Laser-assisted cataract surgery (FLACS) | $4,500/eye | $7,500/eye |
| Toric IOL upgrade (astigmatism correction) | +$1,500/eye | +$2,500/eye |
| Multifocal or extended-depth-of-focus IOL | +$2,000/eye | +$4,000/eye |
| Light Adjustable Lens (LAL) | +$3,000/eye | +$4,500/eye |
A few points about self-pay costs:
Negotiating is possible. Freestanding ASCs often publish cash-pay rates and are more willing to negotiate than hospital systems. Call the billing department directly and ask for the self-pay or cash price. It is not unusual to get 20 to 30% off the sticker price by asking.
Premium IOLs are not covered by Medicare or private insurance. Medicare covers only a standard monofocal IOL as part of CPT 66984. If you want a toric, multifocal, or premium lens, you pay the upgrade cost even if you have Medicare. The surgeon can bill a "facility upgrade" and a "professional upgrade" as separate patient-responsible line items.
Both eyes together rarely costs 2x. Many practices discount the second eye, especially when both are done the same day or the same week. Ask explicitly.
Where to Spot Billing Errors on Your Cataract Surgery Bill
Cataract surgery bills are dense and frequently contain errors. Common problems:
Duplicate facility and surgeon fees for the same day. The facility and surgeon bill separately. That is correct. But if you see the same CPT code billed twice on the same date by the same provider, that is a potential duplicate.
Wrong place-of-service code. If your surgery was at a freestanding ASC but your Explanation of Benefits shows HOPD pricing, you may have been billed at the higher rate. The place-of-service code on the claim should be 24 (ASC) not 22 (HOPD).
Unbundled charges. CPT 66984 is a global code that should bundle the lens implant, the basic IOL, and routine follow-up care in the 90-day postoperative period. Some billers separately charge for the IOL itself (CPT L8610) or for postoperative visits that are included in the global period. That is typically a billing error or, at minimum, something to question.
Upcoding the IOL. If you agreed to a standard monofocal lens but your bill shows a premium lens code, you may be paying for an upgrade you did not request.
Anesthesia time units. Anesthesia is billed in time units, typically 15-minute blocks. A 20-minute cataract surgery should have 2 time units (some anesthesiologists round to 3). If you see 5 or 6 units, ask for documentation.
If you receive your itemized bill and the numbers do not add up, the CoveredUSA Bill Analyzer can compare each charge against Medicare's published rates for CPT 66984 and flag common overcharges in seconds. Upload your itemized statement and it shows you exactly which line items are above expected rates.
Does Medicare Cover Cataract Surgery?
Yes. Medicare Part B covers cataract surgery when it is medically necessary, meaning when the cataract impairs your daily functioning or activities. You do not need a prior authorization. The surgeon documents the medical necessity in the operative note.
What Medicare covers:
- The surgical procedure (CPT 66984 or 66985 for more complex cases)
- Anesthesia
- One standard monofocal intraocular lens
- One pair of standard eyeglasses or contact lenses after each cataract surgery (this is a specific exception to Medicare's usual rule of not covering eyeglasses)
- Preoperative exam and postoperative care within the 90-day global period
What Medicare does not cover:
- Premium IOL upgrades (toric, multifocal, extended depth of focus, light adjustable)
- Laser-assisted surgery (FLACS) is covered only for the manual portion; the laser-assisted component may be a separate patient charge
- Refractive enhancements after surgery
- Designer frames for the covered eyeglasses
Medicare Advantage note: Most Medicare Advantage plans cover cataract surgery at the same level as Original Medicare. However, your cost-sharing depends on your specific plan. An in-network ASC may have a $0 copay while an out-of-network hospital could cost you hundreds. Always verify in-network status before scheduling.
Does Private Insurance Cover Cataract Surgery?
Commercial health insurance generally covers medically necessary cataract surgery, subject to your deductible, coinsurance, and network rules. The patterns are similar to Medicare:
| Coverage Variable | What to Check |
|---|
| Deductible status | Has your annual deductible been met? If yes, you pay only coinsurance. |
| In-network facility | ASC or hospital must be in your plan's network to get in-network cost-sharing |
| Pre-authorization | Many plans require prior auth before scheduling. Get it in writing before surgery day. |
| Premium IOL | Most plans cover only the standard monofocal lens. The upgrade is your cost. |
| Second-eye timing | Some plans apply a separate deductible if the second eye surgery falls in the next plan year. |
Out-of-pocket maximums do provide a ceiling. If you have met your plan's out-of-pocket maximum for the year, the plan pays 100% of covered charges.
How to Reduce What You Pay
Choose an ASC over a hospital. This is the single highest-leverage move available to most patients. Ask your surgeon where they have operating privileges and whether an ASC is available. For a routine cataract, an ASC is safe and produces the same outcomes as a hospital OR.
Schedule both eyes in the same plan year. You only meet your deductible once per year. If the first eye surgery uses up your deductible, the second eye surgery in the same calendar year costs only coinsurance.
Use a Health Savings Account (HSA) or Flexible Spending Account (FSA). Cataract surgery is a qualified medical expense. Paying with pre-tax dollars effectively reduces your cost by your marginal tax rate.
Ask about charity care or financial assistance. If you are uninsured or if the cost is a hardship, hospitals are required under IRS 501(r) rules to have financial assistance programs. Freestanding ASCs are not required to do this, but many have payment plans. Income thresholds vary, but most programs cover patients up to 200% to 400% of the Federal Poverty Level.
Check for billing errors before you pay. This step is often skipped. A 2024 survey found roughly 80% of hospital bills contain at least one error. Upload your itemized cataract surgery bill to the CoveredUSA Bill Analyzer before writing a check. The tool flags place-of-service mismatches, unbundled charges that should be global, and charges above the Medicare benchmark rate.
Medicaid and Cataract Surgery
Medicaid covers cataract surgery for adults in most states, but coverage varies significantly by state. Some states cover only emergency eye care for adults, while others cover elective procedures like cataracts. States that have expanded Medicaid under the ACA generally have broader vision coverage for adult enrollees.
Children covered by Medicaid or CHIP typically have more comprehensive vision benefits, including medically necessary surgery.
If you are on a limited income and uncertain whether you qualify for Medicaid or Medicare Savings Programs that could reduce your Part B cost-sharing, use the eligibility screener at coveredusa.org/screener to check in about two minutes.
Frequently Asked Questions
What is CPT code 66984?
CPT 66984 is the billing code for extracapsular cataract removal with insertion of an intraocular lens prosthesis in one stage, using a manual or mechanical technique. It is the most common CPT code used for standard cataract surgery in the United States. The code covers the removal of the clouded lens and placement of the replacement IOL during a single operative session.
How much does cataract surgery cost with Medicare in 2026?
With Original Medicare Part B, cataract surgery costs approximately $384 per eye at an ASC and approximately $598 per eye at a hospital outpatient department in 2026, assuming you have already met the $283 annual Part B deductible. These figures represent the 20% coinsurance you owe after Medicare pays 80% of the approved amount. Medigap supplemental plans often cover this coinsurance entirely.
Why does the same cataract surgery cost more at a hospital than at a surgery center?
Hospitals bill cataract surgery under the Outpatient Prospective Payment System (OPPS), which sets higher rates than the ASC fee schedule. Medicare approves roughly $1,070 more per procedure at a hospital outpatient department than at an ASC. Since patients pay 20% coinsurance, that translates to about $214 more per eye out-of-pocket for the hospital setting. The clinical procedure is identical.
What is not covered under CPT 66984 even if I have Medicare?
Medicare does not cover premium IOL upgrades such as toric lenses (for astigmatism correction), multifocal lenses, extended depth-of-focus lenses, or light adjustable lenses. The additional surgeon fee and facility fee for the premium lens components are billed as patient-responsible charges on top of the covered CPT 66984 facility fee. Medicare also does not cover laser-assisted surgery beyond the manual portion of the procedure.
How do I know if my cataract surgery bill has errors?
Request your itemized bill, then check for: duplicate procedure codes on the same date, wrong place-of-service code (should be 24 for ASC, not 22 for HOPD if you were at a surgery center), separately billed charges for the IOL itself when CPT 66984 already bundles it, and anesthesia time units that seem excessive for a 15 to 30 minute procedure. The CoveredUSA Bill Analyzer compares each line item against published Medicare rates and flags common cataract billing errors automatically.
Can I negotiate the cost of cataract surgery if I am uninsured?
Yes. Freestanding ASCs are often more flexible than hospital systems. Call the billing department before scheduling and ask for the cash-pay or self-pay rate. Many ASCs post package prices that bundle the surgeon fee, facility fee, anesthesia, and standard IOL. Package prices at ASCs typically run $2,500 to $4,000 per eye, meaningfully lower than the itemized retail rate.
Does Medicare cover cataract surgery for both eyes?
Yes. Medicare Part B covers medically necessary cataract surgery for each eye separately. You do not need both eyes done simultaneously. The procedure on each eye is billed as a separate claim on the date it is performed. If both surgeries happen in the same calendar year and you have already met your Part B deductible, your out-of-pocket for the second eye is typically the same 20% coinsurance as the first.
What is a good total out-of-pocket to expect for cataract surgery on both eyes?
For a Medicare patient choosing an ASC and a standard monofocal IOL: roughly $283 (deductible) plus $384 for the first eye plus $384 for the second eye, totaling around $1,051 for both eyes in a year, before any Medigap coverage. If a Medigap plan covers the coinsurance, total OOP could be close to $0 beyond the monthly premium. For uninsured patients at an ASC using a cash-pay package, budget $5,000 to $8,000 total for both eyes with a standard lens.
