Medicare Blog

how to bill medicare for phaco iol

by Elnora Lehner Published 3 years ago Updated 2 years ago

Is CPT 66984 covered by Medicare?

Medicare and most other insurance carriers specifically exclude coverage for the surgical correction of refractive errors, including astigmatism. 66984 with 67036.

Are intraocular lenses covered by Medicare?

Original Medicare will cover only the cost of conventional monofocal intraocular lenses (lenses that are not presbyopia or astigmatism-correcting). These conventional lenses will give you good distance vision, such as for when you're driving.

What is the CPT code for phacoemulsification with intraocular lens implant?

CPT® defines the code 66982 as: "Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., ...

Does Medicare pay for refractive cataract surgery?

While Medicare doesn't typically cover vision care, such as glasses or contact lenses and eye doctor visits, cataract surgery is the exception. Medicare will pay for cataract surgery if it's done using traditional surgical methods or lasers.Sep 23, 2021

Does Medicare pay for Toric IOL?

The Toric IOL is Medicare approved. Medicare and most insurance companies will cover a portion of the cost of this procedure. New insurance guidelines allow the patient to pay the additional costs associated with the Premium Toric IOL because of its astigmatism correction properties.

Does Medicare pay for astigmatism surgery?

Medicare usually determines that astigmatism correction is not a covered procedure since this can be corrected with glasses.Jul 6, 2014

How do I bill Medicare for post op cataract surgery?

After the optometrist has seen the patient for post-operative care, he/she will submit a claim for the post- operative care provided, using the appropriate CPT Code, i.e, 66984, and Modifier 55.

How do you bill Goniotomy for cataract surgery?

A. Use CPT 65820 (Goniotomy).Mar 1, 2017

What does CPT code 66850 mean?

CPT code 66850 is used when a lensectomy is performed in conjunction with a vitrectomy procedure solely due to CPT instructions. Most retina surgeons and their billers instinctively want to use 66852 because “pars plana approach” is incorporated into the description.

What type of cataract surgery Does Medicare pay for?

Though Medicare will cover both laser and traditional cataract surgeries, they do not yet cover New Technology Intraocular Lenses (NTIOLS). For instance, Medicare may not cover you if you need multifocal or toric lenses, though they will cover monofocal lenses.Jul 15, 2021

Does Medicare pay for cataract evaluation?

While Medicare doesn't cover routine vision screening, it does cover cataract surgery for people over age 65. You may need to pay additional costs such as hospital or clinic fees, deductibles, and co-pays.Oct 29, 2019

Does Medicare pay for laser cataract surgery in 2020?

Medicare coverage and payment for cataract surgery is the same irrespective of whether the surgery is performed using conventional surgical techniques or a bladeless, computer controlled laser. Under either method, Medicare will cover and pay for the cataract removal and insertion of a conventional intraocular lens.Nov 16, 2012

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act §1862 (a) (7) excludes routine physical examinations.

Article Guidance

Documentation Requirements:#N#The following documentation must be present in the medical chart:#N#For Visually-Symptomatic Cataract:

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

Watch out for these potential problem areas

Several compliance issues could come up with the use of intraocular lenses (IOL) used in cataract cases performed on Medicare patients in ASCs. These compliance issues involve the use of premium lenses.

Billing Correctly

First, even though Medicare does not reimburse ASCs any more for the use of premium lenses in their cataract cases than they do for regular IOLs, the ASC still needs to indicate on their Medicare claim form that a premium lens was used in the case. Bill the premium lenses using the V2788 code for PC IOLs or the V2787 code for an AC IOL.

Medicare Reimbursement to ASCs for IOLs

When ASCs bill the 66984, 66982 or other cataract extraction procedure code to Medicare, those codes include the insertion of an IOL in the cataract procedure, and the payment of the cataract CPT code to ASCs includes a $150 allowance as payment for a regular IOL. That does not change when premium lenses are used in the case.

Compliance Issues Involved with Using Premium Lenses

Following are the areas where compliance issues come up with these types of cases:

Does Medicare cover cataracts?

When the only diagnosis is cataract (s), Medicare does not cover testing other than one comprehensive eye examination (or a combination of brief/intermediate examinations not to exceed the charge of a comprehensive examination) plus an appropriate ultrasound scan.

What is cataract removal?

Cataract removal is also indicated when the lens opacity inhibits optimal management of posterior segment disease or the lens causes inflammation (phakolysis, phakoanaphylaxis), angle closure, or medically unmanageable open-angle glaucoma.

Can surgery improve vision?

Surgery will not improve visual function. The patient’s quality of life is not compromised. The patient cannot safely undergo surgery because of coexisting medical or ocular conditions. An informed consent cannot be obtained from the patient or surrogate decisionmaker. Appropriate postoperative care cannot be arranged.

What does "appropriate" mean in medical terms?

Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is: Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.

What is furnished in medical practice?

Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member. Furnished in a setting appropriate to the patient’s medical needs and condition. Ordered and furnished by qualified personnel.

What is posterior segment disease?

The patient has posterior segment disease requiring surgical or laser intervention and where the cataract is an impairment to visualization. Generally, patients with visual acuity of 20/40 or better do not require cataract surgery to improve their ability to carry out activities of daily living.

Watch Out For These Potential Problem Areas

Billing Correctly

  • First, even though Medicare does not reimburse ASCs any more for the use of premium lenses in their cataract cases than they do for regular IOLs, the ASC still needs to indicate on their Medicare claim form that a premium lens was used in the case. Bill the premium lenses using the V2788 code for PC IOLs or the V2787 code for an AC IOL. Append the ...
See more on ascfocus.org

Medicare Reimbursement to ASCS For IOLs

  • When ASCs bill the 66984, 66982 or other cataract extraction procedure code to Medicare, those codes include the insertion of an IOL in the cataract procedure, and the payment of the cataract CPT code to ASCs includes a $150 allowance as payment for a regular IOL. That does not change when premium lenses are used in the case. ASC facilities are still being reimbursed for the place…
See more on ascfocus.org

Compliance Issues Involved with Using Premium Lenses

  • Following are the areas where compliance issues come up with these types of cases: 1. When the surgeon wants to purchase the premium lens for the case and bring it into the ASC for use in the case, it is a compliance issue. Medicare does not allow ASCs to bill for cataract extraction procedures with placement of an IOL with the -52 Reduced Services Modifier or using any other …
See more on ascfocus.org

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