SEP 08, 2021
We fit keratoconus lenses and are questioning coverage. Does Medicare cover the actual lenses?
Question: We fit keratoconus lenses and are questioning coverage. Does Medicare cover the actual lenses?
Answer: No. Medicare via durable medical equipment, does not have an allowable for the actual supply of the keratoconus lenses. Only aphakic contacts are a covered benefit. The patient is responsible for payment. No ABN is necessary and no claim should be submitted. The fitting of the lens is covered by CPT code 92072. Subsequent fittings should be submitted with the appropriate level of E/M or Eye visit code. Effective April 1, 2012, payment for the fitting is inherently bilateral.