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Eye-Surgery Organizations Provide Medicare-Billing Guidance to Physicians for Laser Technology Used in Cataract Procedures 

01/30/2012   12:00:00 PM

Guidelines Establish Roadmap for Ophthalmologists to Use Femtosecond Laser

WASHINGTON AND FAIRFAX, Va. – Two medical associations, representing the nearly all of ophthalmic surgeons in the United States, today issued guidelines to assist ophthalmologists in determining their ability to charge Medicare and/or its beneficiaries for use of emerging laser technology. The American Academy of Ophthalmology, the world's largest association of eye physicians and surgeons, and the American Society of Cataract and Refractive Surgery, whose members specialize in anterior segment ophthalmic surgery, developed the guidance to clarify when ophthalmologists may charge to use the femtosecond laser during cataract surgery. The device creates rapid bursts of laser energy, which are measured in femtoseconds.

The femtosecond laser provides a new approach to cataract surgery. This technology has been used by ophthalmologists for more than a decade in procedures including refractive surgery and corneal transplantation. The U.S. Food and Drug Administration in 2009 approved expanded use of a femtosecond laser that reaches deep enough into the eye to be used as an adjunct in cataract removal. The availability of new technology, however, does not mean it will be paid for by Medicare.

These guidelines, which only apply to the Medicare fee-for-service program, are issued in response to inquiries from ophthalmologists regarding the appropriateness of charging for laser use in certain clinical situations. Developed with input from ophthalmologists, legal counsel and manufacturers, the guidance outlines instances when it is clearly permissible to bill – or not bill – to use this technology:

  • Providers may not bill Medicare, a beneficiary, or his or her secondary insurer for additional fees to perform covered components of cataract surgery with a femtosecond laser.
  • Providers may bill the patient an additional fee for using the femtosecond laser when performing a refractive lens exchange because the procedure is not covered by Medicare.
  • Providers should not use the differential charge allowed for implantation of a premium intra-ocular lens to recover the costs of using the femtosecond laser for cataract surgical steps.

"The American Academy of Ophthalmology, in partnership with the American Society of Cataract and Refractive Surgery, is clarifying the incorporation of new technology to treat patients whose vision is impaired by a cataract," said David W. Parke II, MD, CEO of the American Academy of Ophthalmology. "Ophthalmologists are fortunate to have access to emerging technology such as the femtosecond laser. This guidance provides additional information for ophthalmologists to consider when deciding on the best care for their patients."

The guidelines, developed by the Academy and ASCRS for billing Medicare and its beneficiaries when using the femtosecond laser, are subject to modification based on any new regulations issued by CMS or its contractors. The organizations suggest that ophthalmologists seek additional guidance directly from their Medicare carriers for coverage determinations under Medicare Part C or through commercial carriers.

"Over the past few months, cataract and refractive surgeons have had numerous questions about Medicare coverage of the use of this new technology," said Edward J. Holland, MD, president of the American Society of Cataract and Refractive Surgery. "ASCRS has worked closely with the Academy, legal experts and other stakeholders to develop this billing guidance such that our members may be confident that they are conforming to current Medicare requirements."|

Guidelines for Billing Medicare Beneficiaries When Using the Femtosecond Laser
can be found on the Academy website at http://www.aao.org/outofcs/wre/FS_Laser_Guideline_Doc_01_30_12.pdf
and the ASCRS website at http://www.ascrs.org/emails/www/01-30-12 FS Laser Guideline Document.pdf.

About the American Academy of Ophthalmology
The American Academy of Ophthalmology is the world's largest association of eye physicians and surgeons — Eye M.D.s — with more than 30,000 members worldwide. Eye health care is provided by the three "O's" – ophthalmologists, optometrists, and opticians. It is the ophthalmologist, or Eye M.D., who can treat it all: eye diseases, infections and injuries, and can also perform eye surgery. For more information, visit www.aao.org. The Academy's EyeSmart® public education program works to educate the public about the importance of eye health and to empower them to preserve their healthy vision, by providing the most trusted and medically accurate information about eye diseases, conditions and injuries. Visit www.geteyesmart.org to learn more.

About ASCRS
The American Society of Cataract and Refractive Surgery (ASCRS) is an independent non-profit organization founded in August of 1974 to disseminate information about anterior segment ophthalmic surgery. Since 1974, ASCRS has seen anterior segment surgery develop into a highly sophisticated form of ophthalmic treatment. Through its educational programs and services, ASCRS has become the physicians' primary source of up-to-date information on scientific developments within the field, as well as the regulatory decisions that affect ophthalmic practices.

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