Does medicare cover new glasses after cataract surgery

Q: Will Medicare reimburse me for glasses after cataract surgery?

Part B covers certain doctors services, outpatient care, medical supplies, and preventive services. helps pay for corrective lenses if you have cataract surgery that implants an intraocular lens. Corrective lenses include one pair of eyeglasses with standard frames or one set of contact lenses.

Q: Will Medicare pay for bifocals after cataract surgery?

Medicare also doesnt cover eyeglass extras” like bifocals, tinted lenses, scratch resistant coating, or any contact-lens accessories. Youll be responsible for any extra costs if you choose to get upgraded frames.

Q: What type of glasses will I need after cataract surgery?

Often, its a good idea to purchase a pair of glasses for use as needed after cataract surgery. To see your best at all distances, progressive lenses often are the best solution. If sensitivity to light is a problem, photochromic lenses that darken automatically in sunlight usually are a great choice.

Table of Contents Show

Diagnoses to report
CPT codes to report
Claims submission
Fees for DME suppliers
Will Medicare reimburse me for glasses after cataract surgery?
Will Medicare pay for bifocals after cataract surgery?
What is not covered by Medicare for cataract surgery?
What type of glasses will I need after cataract surgery?

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Routine eye care services, such as regular eye exams, are excluded from Medicare coverage. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare covers:

Surgical procedures to help repair the function of the eye due to chronic eye conditions. For example, Medicare will cover surgery to remove a cataract and replace your eye’s lens with a fabricated intraocular lens.
Eyeglasses or contacts if you had an intraocular lens placed in your eye after cataract surgery. In this case, Medicare will cover a standard pair of untinted prescription eyeglasses or contacts if you need them. If it is medically necessary, Medicare may pay for customized eyeglasses or contact lenses.
An eye exam to diagnose potential vision problems. If you are having vision problems that may indicate a serious eye condition, Medicare will cover an exam. Your exam is covered even if it turns out you do not have a vision problem.

Medicare only covers routine eye care in the following circumstances:

If you have diabetes, Medicare covers an annual eye exam by a state-authorized eye doctor to check for diabetes-related vision problems.
If you are at high risk for glaucoma, Medicare covers an annual eye exam by a state-authorized eye doctor. You are considered to be at high risk if you:
- Have diabetes
- Have a family history of glaucoma
- Are African American and age 50+
- Or, are Hispanic American and age 65+

Excerpted from page 44 of the March 2018 edition of AOA Focus.

AOA's coding experts frequently receive questions regarding the appropriate coding for postoperative glasses. Here's what you need to know:

Coverage

Medicare will cover one pair of eyeglasses or contact lenses as a prosthetic device furnished after each cataract surgery with insertion of an intraocular lens (IOL). Replacement frames, eyeglass lenses and contact lenses are noncovered.

Frequency

Medicare will pay for one pair of post-cataract surgery glasses per lifetime per eye after cataract surgery. You also should review any local coverage determinations (LCDs) to find out if there are any local policy stipulations. Additionally, you also may want to call the Durable Medical Equipment Regional Carrier for your area to see if the patient is presently eligible for the glasses. Some LCDs clarify, "If a beneficiary has a cataract extraction with IOL insertion in one eye, subsequently has a cataract extraction with IOL insertion in the other eye, and does not receive eyeglasses or contact lenses between the two surgical procedures, Medicare covers only one pair of eyeglasses or contact lenses after the second surgery. If a beneficiary has a pair of eyeglasses, has a cataract extraction with IOL insertion, and receives only new lenses but not new frames after the surgery, the benefit would not cover new frames at a later date (unless it follows subsequent cataract extraction in the other eye)."

Diagnoses to report

Payable diagnosis codes include:

Z96.1 (pseudophakia)
H27.01, H27.02, H27.03 (aphakia)
Q12.3 (congenital aphakia)

CPT codes to report

For one or two lenses, bill the correct Healthcare Common Procedure Coding System code (V21xx, V22xx, or V23xx) on separate lines for each eye; use modifier RT or LT and the fee for one lens at your standard fee.

Claims submission

If you are billing for eyeglasses or contact lenses, you should submit claims to your Medicare Durable Medical Equipment Administrative Contractor (DME MAC). Find a list of DME MACs.

Fees for DME suppliers

All suppliers of Durable Medical Equipment, Orthotics and Prosthetics (DMEPOS), including eyeglasses and contact lenses for postoperative cataract patients, are subject to an enrollment and revalidation fee. The AOA continues to advocate with the Centers for Medicare & Medicaid Services so that doctors who are enrolled in Medicare as physicians should be exempt from this fee.

To stay abreast of code changes and the latest coding information, access the AOA's coding resources:

Online resources. For up-to-date codes and resources, access AOA's coding information at aoa.org/coding and AOA Coding Today.
Got a coding question? If you have specific coding questions that are not addressed through AOA Coding Today, direct them to AOA's Coding Experts by completing the online form.
Reference manuals. Purchase the 2018 CPT code bundle at AOA Marketplace.

If you have suggestions on how the AOA can best support the coding needs of doctors of optometry, please contact Kara Webb, AOA's associate director for coding and regulatory policy, by email or call 703.837.1018.

Will Medicare reimburse me for glasses after cataract surgery?

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. helps pay for corrective lenses if you have cataract surgery that implants an intraocular lens. Corrective lenses include one pair of eyeglasses with standard frames or one set of contact lenses.

Will Medicare pay for bifocals after cataract surgery?

Medicare also doesn't cover eyeglass “extras” like bifocals, tinted lenses, scratch resistant coating, or any contact-lens accessories. You'll be responsible for any extra costs if you choose to get upgraded frames.

What is not covered by Medicare for cataract surgery?

Both Original Medicare and Medicare Advantage cover cataract surgery, which is noteworthy because Medicare doesn't cover routine eye exams. In order for surgery to be covered, it must be done using traditional surgical techniques or lasers. Original Medicare covers 80% of the cost of cataract surgery, says Cameron E.

What type of glasses will I need after cataract surgery?

Often, it's a good idea to purchase a pair of glasses for use as needed after cataract surgery. To see your best at all distances, progressive lenses often are the best solution. If sensitivity to light is a problem, photochromic lenses that darken automatically in sunlight usually are a great choice.