Medicare Reimbursement for Toric IOLs
Most intraocular lenses (IOLs) contain only spherical power, and do not correct astigmatism. IOLs with both sphere and cylinder power, also known as toric IOLs, can correct astigmatism and reduce the amount of residual refractive error following cataract surgery.
This monograph examines how toric IOLs factor into the longstanding coverage and payment rules for cataract surgery. It addresses those IOL features and related professional services that are considered non-covered based on the pertinent January 22, 2007, ruling of the Centers for Medicare & Medicaid Services (CMS-1536-R) concerning astigmatism-correcting IOLs (see Appendix). It also identifies the applicable CPT and HCPCS codes, as well as ICD-9 diagnosis codes that pertain to the professional and facility services related to cataract surgery and the implantation of toric IOLs. Relevant modifiers are noted as well.
To fully address this topic, we consider:
1) the toric IOL itself,
2) additional diagnostic testing required to choose and use a toric IOL,
3) additional intraoperative steps required to implant and orient the toric IOL, and
4) additional postoperative care that might be necessary following implantation of a toric IOL.
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