NOV 28, 2012
The Centers for Medicare & Medicaid Services (CMS) has clarified the issue of when beneficiaries can be billed for non-Medicare-covered services when using a femtosecond laser for cataract surgery.
The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery accordingly updated joint guidelines released earlier this year for billing Medicare and beneficiaries when using the femtosecond laser.
In the guidance, CMS states that Medicare coverage and payment for cataract surgery using a "bladeless, computer-controlled laser" should follow the same rules as conventional cataract surgery. Therefore, cataract removal and the insertion of conventional IOLs will be fully covered regardless of which method is used. However, physicians will be allowed to charge for non-covered services when implanting a presbyopia-correcting IOL or astigmatism-correcting IOLs using either method.
This ruling will allow billing for the image-guided portion of the femtosecond laser surgery in cases that include implantation of a PC-IOL with or without astigmatic correction.
Issued in response to a press release from an ophthalmic practice that implied a different Medicare policy, the guidance reiterated the intent of Rulings 05-01 (issued May 3, 2005) and 1536-R (effective for services on and after January 22, 2007), which stated that Medicare will allow beneficiaries to pay additional charges not covered by Medicare associated with insertion of a PC-IOL and AC-IOL, respectively. Those same rules will apply to the use of laser cataract surgery.
"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," according to the CMS guidance.
The guidance continued: "If the bladeless, computer controlled laser cataract surgery includes implantation of a PC-IOL or AC-IOL, only charges for those noncovered services specified above may be charged to the beneficiary. These charges could possibly include charges for additional services, such as imaging, necessary to implant a PC-IOL or an AC-IOL, but that are not performed when a conventional IOL is implanted. Performance of such additional services by a physician on a limited and nonroutine basis in conventional IOL cataract surgery would not disqualify such services as noncovered services. This guidance does not apply to the use of technology for refractive keratoplasty."
Read the CMS guidance document.