Payment for CPT code 66892, 66893, 66894 and covered DX v27.87

Payment and Coding for Presbyopia-Correcting IOLs (P-C IOLs and Astigmatism-Correcting Intraocular Lens (A-C IOLs)

Effective for dates of service on or after January 1, 2008, when inserting an approved A-C IOL in an ASC, V2787 should be billed to report the non-covered charges for the A-C IOL functionality of the inserted intraocular lens. Additionally, note that V2788 is no longer valid to report non-covered charges associated with A-C IOL. However, this code continues to be valid to report non-covered charges for P-C IOL. The payment for the conventional lens portion of the A-C IOL and P-C IOL continues to be bundled with the ASC procedure payment.

• Medicare will pay the same amount of cataract extraction with A-C IOL insertion that is paid for cataract extraction with conventional IOL insertion.

• The patient is responsible for payment of that portion of the ASC charge for the procedure that exceeds the facility’s usual charge for cataract extraction and insertion of a conventional IOL following cataract surgery, as well as any fees that exceed the physician’s usual charge to perform a cataract extraction with insertion of a conventional IOL.

The Social Security Act specifically excludes eyeglasses and contact lenses from coverage, with an exception for one pair of eyeglasses or contact lenses covered as a prosthetic device furnished after each cataract surgery with insertion of an IOL. In addition, there is no Medicare benefit category to allow payment for the surgical correction or cylindrical lenses of eyeglasses or contact lenses that may be required to compensate for the imperfect curvature of the cornea (astigmatism).

• Medicare will not make a separate payment to the ASC 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.

• Any person or ASC, who presents or causes to be presented a bill or request for payment for an IOL inserted during or subsequent to cataract surgery for which payment is made under the ASC fee schedule, is subject to a civil money penalty.

For A-C IOLs inserted subsequent to removal of a cataract in a hospital (outpatient or inpatient) setting:
• The facility should bill for removal of a cataract with insertion of a conventional IOL, regardless of whether a conventional A-C IOL is inserted. When a beneficiary receives an A-C IOL following removal of a cataract, ASCs should report the same CPT code that is used to report removal of a cataract with insertion of a conventional IOL.

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

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

For an A-C IOL inserted following removal of a cataract in an ASC:

• A physician may not 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 required to insert and adjust an A-C IOL following removal of a cataract, which exceed physician charges for services and supplies required for the insertion of a conventional IOL.

• 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, which exceed the physician charges for services and supplies required to examine and monitor a beneficiary following cataract surgery with insertion of a conventional IOL.
No new codes are being established at this time to identify an A-C IOL or procedures and services related to an A-C IOL, and hospitals, ASCs and physicians should report one of the following CPT codes to bill Medicare for removal of a cataract with IOL insertion:

• CPT code 66982© – Cataract surgery, complex.
• CPT code 66983© – Cataract surg w/iol, 1 stage.
Or,
• CPT code 66984© – Cataract surg w/iol, 1 stage

Billing Requirements Effective January 1, 2008

• When inserting an approved A-C IOL, code V27.87 should be billed to report the non-covered charges for the A-C IOL functionality of the inserted IOL.
• Code V2788 is no longer valid to report non-covered charges associated with the A-C IOL.
• Code V2788 is valid to report non-covered charges of a Presbyopia-Correcting (P-C) IOL.
• Payment for the conventional lens portion of the A-C IOL will continue to be bundled with the facility procedure payment for ASCs.