Summary of Changes
This instruction announces a new CMS Administrator Ruling regarding astigmatism-correcting intraocular lenses (A-C IOLs) following cataract surgery.
Background
Astigmatism-correcting IOLs are intended to provide improved near, intermediate, and distance vision for patients with pre-existing astigmatism.
Policy
Medicare does not make separate payment for an IOL inserted subsequent to extraction of a cataract. Payment for the IOL is packaged into the payment for the surgical cataract extraction/lens replacement procedure.
Facilities and ASCs shall bill for removal of a cataract with insertion of a conventional IOL, regardless of whether a conventional or astigmatism-correcting IOL is inserted.
There is no Medicare benefit category that allows payment of facility charges for services and supplies required to insert and adjust an astigmatism-correcting IOL following removal of a cataract that exceed the facility charges for services and supplies required for the insertion and adjustment of a conventional IOL.
Manual:
Download: Instructions for Implementation of CMS 1536-R; Astigmatism-Correcting Intraocular Lens (A-C IOLs)
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