• Medically necessary 67036 claim denied for Medicare patient with cataract fragments in left eye following cataract surgery. Why?


    My retinal doctor has charged 67036 for a Medicare patient with diagnosis H59.02 cataract (lens) fragments in eye following cataract surgery, left eye. The claim was denied as not medically necessary. Why? 

    Medicare has a national coverage determination (NCD) for vitrectomy. All NCDs can be found on aao.org/lcds. H59.02- cataract fragments in the eye following cataract surgery are not a covered ICD-10 per the NCD 80.11.