Surgical Correction of Corneal Astigmatism

“Astigmatism may be either pre-existing or iatrogenic (e.g., induced by the effects of treatment, usually surgery).  Medicare covers refractive surgery in the rare instances when it is performed to correct a surgical complication or trauma.  Surgically induced astigmatism may be covered; treatment of pre-existing astigmatism is considered refractive surgery and is non-covered.”

This FAQ addresses the following:

  1. What options are available for the correction of corneal astigmatism?
  2. Does Medicare cover surgery to correct corneal astigmatism?
  3. Does Medicare specify the amount of surgically induced astigmatism that must be present to be covered?
  4. If the payer determines that SCOCA is covered, how should the procedure be coded?
  5. Why doesn’t Medicare cover procedures to correct pre-existing astigmatism?
  6. How do we identify refractive surgical procedures for correction of pre-existing astigmatism?
  7. Are special tests required prior to surgery?
  8. Will these tests be reimbursed?

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