Payment Policy for an A-C IOL Inserted Following Removal of a Cataract in Surgery Centers

The following Q&A comes from the Centers for Medicare & Medicaid Services website.

 

Q: What is the payment policy for an Astigmatism-Correcting Intraocular Lens (A-C IOL) inserted following removal of a cataract in a hospital or Ambulatory Surgical Center (ASC)?

 

CMS: The payment policy for an A-C IOL inserted following removal of a cataract in a hospital or ASC is:

 

• A physician cannot bill Medicare for the A-C IOL inserted during a cataract procedure performed in those settings because payment for the lens is included in the payment made to the facility for the entire procedure;


• There is no Medicare benefit category that allows payment of physician charges for services and supplies require to insert and adjust an A-C IOL following removal of a cataract that exceed physician charges for services and supplies required for the insertion of a conventional IOL; and


• There is no Medicare benefit category that allows payment of physician charges for subsequent treatments, services and supplies required to examine and monitor a beneficiary following removal of a cataract with insertion of an A-C IOL that exceed the physician charges for services and supplies required to examine and monitor a beneficiary following cataract surgery with insertion of a conventional IOL.

Reference: http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM5527.pdf;
http://www.cms.hhs.gov/transmittals/downloads/R1228CP.pdf

 

Source: CMS

 

Read more ASC coding guidance:

 

- Guidance for Properly Reporting Modifier -33

 

- 17 Steps to Take When a Payor Changes Payment System From Medicare-Grouper to APC-Based

 

- 2011 CPT Changes to the Integumentary System

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