• 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
