CPT Code 00142: Anesthesia for Lens Surgery (Cataract) — Complete Billing & Coding Guide
What Does CPT Code 00142 Mean?
CPT code 00142 describes anesthesia services provided for procedures on the lens of the eye, most commonly cataract extraction with intraocular lens (IOL) implantation. This code is more specific than CPT 00140 (general eye procedures) and is the preferred code when the surgical procedure is confined to the lens. Cataract surgery is one of the most frequently performed surgical procedures in the United States, with over 2 million cases annually, making 00142 one of the most commonly billed anesthesia codes in ambulatory surgery centers.
Key Code Attributes:
- Billable Status: Fully billable as a standalone anesthesia service
- Base Units (CMS 2026): 4
- Primary Setting: Ambulatory surgery center (most common), hospital outpatient department, or dedicated eye surgery center
- Provider Type: Anesthesiologist (MD/DO), CRNA with physician supervision, or anesthesia assistant under physician direction
- Service Category: Monitored anesthesia care (MAC) — majority of cases; general anesthesia for complex or uncooperative patients
- Effective Status: Active CPT code with no planned retirement (verified through 2026)
- Typical Patient Population: Elderly patients (65+) with age-related cataracts; Medicare is the primary payer for the majority of cases
What Services and Procedures Does CPT Code 00142 Cover?
CPT 00142 covers anesthesia for surgical procedures confined to the crystalline lens of the eye, including both the native lens and intraocular lens implants. The code applies regardless of the surgical technique (phacoemulsification, extracapsular, or intracapsular).
Covered Procedures and Surgical Indications:
- Phacoemulsification cataract extraction with posterior chamber intraocular lens implantation
- Extracapsular cataract extraction (ECCE) with IOL implantation
- Intracapsular cataract extraction (ICCE) — rare, for subluxated lenses
- Secondary intraocular lens implantation (sulcus fixation or scleral fixation)
- Intraocular lens exchange or repositioning
- Lens fragment removal following complicated cataract surgery
- Refractive lens exchange (clear lens extraction for high refractive error)
- Combined cataract surgery with limited anterior vitrectomy (lens fragment in anterior chamber)
What Does CPT 00142 Specifically Exclude?
| Excluded Procedure | Correct Code | Rationale |
|---|---|---|
| Combined cataract with glaucoma surgery (trabeculectomy or tube shunt) | CPT 00140 | Multiple eye structures — use general eye code |
| Combined cataract with corneal transplant (triple procedure) | CPT 00140 | Corneal involvement requires broader code |
| Combined cataract with vitrectomy | CPT 00140 or 00145 | Posterior segment involvement |
| Corneal transplant alone | CPT 00144 | Corneal procedure |
| Vitreoretinal surgery alone | CPT 00145 | Posterior segment |
| Pediatric lens surgery (patient under 1 year) | CPT 00148 | Age-specific code with higher base units |
| Iridectomy alone | CPT 00147 | Iris procedure |
When Is CPT Code 00142 the Right Code to Use?
Step-by-Step Code Selection Criteria
- Confirm the primary procedure is lens surgery — cataract extraction with IOL implantation is the most common
- Check for combined procedures — if cataract is combined with glaucoma, corneal, or vitreoretinal surgery, use CPT 00140 instead
- Verify patient age — use CPT 00148 for patients under 1 year of age
- Document anesthesia type — MAC (modifier QS) for standard cases; general anesthesia for complex cases, patient anxiety, or inability to cooperate
- Document regional block — peribulbar or retrobulbar block performed by anesthesia provider is included in the anesthesia service
Comparison With Related Eye Anesthesia Codes
| Code | Anatomic Focus | Base Units (2026) | Typical Use |
|---|---|---|---|
| 00142 | Lens | 4 | Cataract extraction with IOL |
| 00140 | Eye (general) | 4 | Combined procedures, glaucoma, strabismus |
| 00144 | Cornea | 4 | Penetrating keratoplasty, DSEK, DMEK |
| 00145 | Vitreoretinal | 5 | Vitrectomy, retinal detachment |
| 00147 | Iris | 4 | Iridectomy |
| 00148 | Eye — under 1 year | 5 | Congenital cataract, infant eye surgery |
Documentation Requirements
What Must the Provider Document?
Preoperative Documentation:
- Patient history and physical with cardiopulmonary assessment
- ASA Physical Status Classification — elderly cataract patients commonly have multiple comorbidities
- Anesthesia plan — MAC with monitored sedation
- Anticoagulant and antiplatelet medication review — critical for block safety
- NPO status verification
Intraoperative Documentation:
- Anesthesia start and stop times (continuous face-to-face care)
- Vital signs at minimum 5-minute intervals
- Type, dose, route, and time of all sedative and analgesic agents
- Level of sedation documented (Ramsay scale or MOAA/S score)
- Oxygen administration method and rate
- Peribulbar or retrobulbar block documentation (if performed — agents, volume, technique)
- Complications — oculocardiac reflex, hypotension, hypoxia, allergic reaction
Postoperative Documentation:
- PACU admission and discharge times
- Pain scores and analgesic administration
- Nausea/vomiting assessment
- Visual acuity check if applicable
- Aldrete score or equivalent
Base Unit Assignment and Time Calculation
| Component | Value |
|---|---|
| Base Units (CMS 2026) | 4 |
| Time Unit Increment | 15 minutes |
| Physical Status P3 | +1 unit |
| Physical Status P4 | +2 units |
| Physical Status P5 | +3 units |
Reimbursement
2026 RVU Breakdown for CPT 00142
| Component | Facility Value |
|---|---|
| Work RVU | 1.20 |
| Practice Expense RVU | 0.06 |
| Malpractice RVU | 0.07 |
| Total RVU | 1.33 |
| Estimated Medicare Payment | ~$44-48 |
Payer Considerations
- Medicare: Cataract surgery is a covered benefit. Anesthesia is reimbursed separately when a qualified anesthesia provider is involved. Medicare does not cover routine pre-operative testing unless medically indicated
- Commercial Payers: Most cover cataract anesthesia. Some require prior authorization for GA instead of MAC
- Medicare ASC: Cataract surgery in ASCs is common; anesthesia is separately billable
- Regional Block: Peribulbar block by anesthesia is included (not separately billable)
Common Modifiers
| Modifier | Use Case |
|---|---|
| AA | Anesthesiologist personally performs service |
| QS | Monitored anesthesia care (MAC) — very common for cataract |
| QK | Medical direction of 2-4 concurrent cases |
| QX | CRNA with medical direction |
| QZ | CRNA without medical direction |
| P1-P6 | ASA physical status |
| 23 | Unusual anesthesia |
What Codes Are Commonly Billed Alongside CPT 00142?
| Code/Service | Guidance |
|---|---|
| 66984 (cataract surgery) | Surgical code billed by surgeon |
| Peribulbar/retrobulbar block | Bundled — do not bill separately |
| Qualifying circumstances (99100-99140) | Add if applicable |
| Pre-operative evaluation | Included in anesthesia |
Coding Errors to Avoid
- Using 00140 when 00142 is more specific — Both have same base units, but 00142 is preferred for lens-only procedures
- Billing when surgeon used topical drops alone — No anesthesia code if no anesthesia provider involved
- Billing regional block separately — Peribulbar block by anesthesia provider is bundled
- Bilateral cataract coded as two units — Single anesthetic session = one CPT 00142
- Missing QS modifier for MAC — Append QS when MAC is provided
Real-World Scenario
A 78-year-old male with visually significant cataract (right eye) and history of hypertension (controlled) and diabetes (well-controlled) undergoes phacoemulsification with IOL implantation under MAC. The anesthesia provider administers propofol sedation and performs a peribulbar block. Total anesthesia time is 25 minutes. ASA II.
Coding: CPT 00142 + AA + P2 + QS. Base 4, time 1, total 5 units.
Frequently Asked Questions
Is CPT 00142 the Standard Code for Cataract Anesthesia?
Yes. CPT 00142 is the standard and preferred anesthesia code for cataract extraction with IOL implantation. It is more specific than CPT 00140 and is recognized by all major payers.
Can CPT 00142 Be Billed for MAC?
Yes. MAC with modifier QS is the most common billing approach for cataract anesthesia. The anesthesia provider documents sedation, monitoring, and block administration.
Is the Peribulbar Block Separately Billable?
No. When the anesthesia provider performs a peribulbar or retrobulbar block for cataract surgery, it is included in the anesthesia service (CPT 00142) and is not separately billable.
What If the Surgeon Uses Topical Anesthesia Alone?
If the surgeon performs cataract surgery under topical anesthesia (drops or gel) without anesthesia provider involvement, no anesthesia code is reported. CPT 00142 requires the presence of a qualified anesthesia provider.
How Is Combined Cataract-Glaucoma Surgery Coded?
When cataract surgery is combined with a glaucoma procedure (trabeculectomy or tube shunt) during the same anesthetic session, CPT 00140 (general eye) is the appropriate code.
Key Takeaways
- CPT 00142 is specific to lens/cataract surgery — more specific than 00140
- Base units 4; same reimbursement as 00140 but clinically preferred for lens cases
- MAC with QS modifier is standard practice
- Peribulbar block by anesthesia is bundled — do not bill separately
- Not reportable for topical anesthesia alone by surgeon
- Single code per session regardless of unilateral or bilateral
References
- CMS PFS: cms.gov/apps/physician-fee-schedule
- ASA Relative Value Guide — annual reference
- CMS Chapter 12 — Anesthesia billing guidance
- American Academy of Ophthalmology — Preferred Practice Pattern for Cataract
