Covered or Noncovered? The Cataract Menu – Review of Ophthalmology

What Medicare covers is not always clear-cut. A breakdown of cataract surgery and the rationale for who pays what.

This article answers the following questions:

  • Does Medicare cover all items and services associated with cataract surgery?
  • Which items and services associated with cataract surgery are covered by Medicare?
  • If we perform both an A-scan (76519) and an IOLMaster (92136), may we bill one of the tests to the patient as a noncovered test?
  • Does Medicare cover anything else associated with cataract surgery?
  • If diagnostic tests are performed in the postoperative period after cataract surgery, are they covered by Medicare?
  • Are Medicare beneficiaries required to sign an ABN before receiving any non-covered items or services?
  • Are there diagnostic tests that may be offered to cataract patients that would be considered noncovered by Medicare?
  • Are there any noncovered charges for evaluation and treatment of astigmatism at the time of cataract surgery?
  • Are there any noncovered charges associated with patients considering pseudophakic monovision?
  • Does the patient get to decide whether to have these noncovered tests?
  • Are there any noncovered services associated with conventional IOLs within an ambulatory surgery center?
  • Does the patient benefit from having these noncovered tests and services?

This article was published in Review of Ophthalmology’s Medicare Q & A column, which is written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA. To view the entire article in Review of Ophthalmology, click on the link below:

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