Excerpted from page 44 of the March 2018 edition of AOA Focus. Show
AOA's coding experts frequently receive questions regarding the appropriate coding for postoperative glasses. Here's what you need to know: CoverageMedicare 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. FrequencyMedicare 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 reportPayable diagnosis codes include:
CPT codes to reportFor 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 submissionIf 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 suppliersAll 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:
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. En español | No. Medicare doesn’t cover eyeglasses, contact lenses or eye exams to determine your prescriptions. However, you’ll find one exception: Medicare provides limited coverage for glasses or contact lenses after cataract surgery. When does Medicare cover glasses and contacts?Medicare Part B will pay for one set of corrective glasses or contacts if you have cataract surgery that implants an intraocular lens, the clear plastic artificial lens that doctors put in place when removing your cloudy natural lens. After you’ve met your annual Part B deductible, which is $233 in 2022, you’ll pay 20 percent of the Medicare-approved amount for corrective lenses after your cataract surgery. In this case, Medicare will cover only one set of contacts or pair of glasses with standard frames. Upgraded frames may mean extra costs out of pocket for you. And you must purchase the glasses from an enrolled Medicare supplier. Does Medicare Advantage cover glasses and contacts?If you choose to enroll in a Medicare Advantage plan rather than original Medicare, you’ll discover that most plans offer some vision coverage for eye exams, glasses and contacts. Most forego the copayment for glasses and contacts too. All vision coverage — including eye exams, glasses and contacts — within Medicare Advantage plans usually has an annual dollar limit, which averaged $160 in 2021, according to the Kaiser Family Foundation. These plans also have limits on how often you can get a new pair of glasses. About half cover one pair a year. Others cover a pair every two years. To check out plans with vision coverage in your area, go to Medicare’s Plan Finder and type in your zip code. In the Plan Type drop-down menu, click ◯ Medicare Advantage Plan and hit the Apply button to register your choice. You then may be asked to choose your county if your zip code spans more than one county. When you click Start, you can identify if you receive financial aid and see an option to compare drug costs among plans. This doesn’t include vision costs. From there, you can click through to see a list of all Medicare Advantage plans in your area. A green check mark notes ✓ Vision in the Plan Benefits list. You can narrow the list by clicking on Filter by: Plan Benefits, checking the box beside ☐ Vision coverage, and hitting the Apply button. For more information about each plan’s vision coverage, click Plan Details and either scroll down to Extra Benefits or click on the tab with that name. Under Vision, you’ll see whether the plan has a copay for routine eye exams, glasses, contacts and other covered services and what limits might apply. You also can go to a plan’s website or contact the plan directly for more information. Some plans require using an in-network provider and getting prior authorization for some vision services. Can I get other coverage for glasses and contacts?Yes, you can get some help paying for glasses — and contacts: Medicaid. If you qualify for this joint federal-state or federal-territory program that provides health insurance for people with low incomes, you may have some coverage for glasses. The rules vary a lot by location. Some states and territories cover one pair of glasses every two years, some every five years, and others pay for glasses only if you have cataract surgery. A few Medicaid programs won’t cover glasses for adults. Contact your state Medicaid program to learn more. Retiree coverage. Many retiree health plans have some coverage for glasses and contacts. Check your plan’s website or call your benefits administrator for details. Veterans benefits. The U.S. Department of Veterans Affairs (VA) will cover the cost of glasses if you have a service-connected disability and are receiving VA disability payments or if you were awarded a Purple Heart or meet other service-related criteria. The VA is a separate health care system from Medicare. If you’re receiving VA care for an illness or injury that is causing vision problems, such as cataract surgery, diabetes, multiple sclerosis, stroke or traumatic brain injury you may be able to get coverage for glasses. To find out more, contact a VA health facility near you. Vision insurance or discount programs. With a private vision insurance policy, you pay annual premiums and usually have a copayment for eye exams, glasses or contacts and an annual vision coverage maximum. With a discount program, you pay a monthly fee for discounted eye exams, glasses and contacts within a network of doctors and vision centers. AARP members have access to vision insurance and discounts at national optical chains through EyeMed MyVision Care. Keep in mindA few Medigap companies let you add an optional package of extra benefits that cover some in-network vision, dental and hearing exams and one pair of glasses or contacts each year, up to an annual limit. The end of a year, before the start of a school year and holidays can be a good time to look for sales on prescription
eyewear, often the frames. If you like a style at one retailer, ask when it will be on sale, when coupons are offered or whether the store has discounts based on age or organizations where you might have a membership. Comparison shop at membership warehouses with vision centers and online retailers. Money from a health savings account (HSA) that you contributed to before you enrolled in Medicare can be used for glasses. And if the frames you’re wearing now are in good shape, see if new lenses only will cut your costs significantly. Updated September 26, 2022 Does Medicare provide free 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.
Is there a time limit to get glasses after cataract surgery?When should I get new eyeglasses made? It is usually advisable to wait for closer to a month following surgery before getting any new prescription eyeglasses. Because the prescription may not be stable until then, doing this too soon may result in having to change your eyeglasses a second time.
What type of lens does Medicare cover for cataract surgery?Original Medicare covers: An intraocular lens (IOL), which is a small, lightweight disc that replaces the eye's natural lens affected by the cataract. Facility and doctor services during surgery. One pair of prosthetic eyeglasses or contact lenses.
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What is the medicare approved amount for eyeglasses after cataract surgery
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