Medicare Reimbursement for Surgery to Correct Anisometropia

Refractive errors following cataract surgery can usually be corrected with eyeglasses or contact lenses.  Occasionally, the refractive error is large enough to create anisometropia that cannot be corrected with eyeglasses or contact lenses, and an additional surgery is warranted.

There are two surgical options for Medicare-covered procedures.  The surgeon can either exchange the IOL, or implant a “piggyback” lens.  A piggyback IOL is placed on top of the first IOL.

This FAQ addresses the following:

  1. Following cataract surgery, some patients have refractive errors.  What are the treatment options?
  2. What is clinically significant anisometropia?
  3. When is surgery warranted to correct anisometropia?
  4. What are the surgical options for correcting anisometropia?
  5. What codes describe IOL exchange and insertion of a piggyback IOL?
  6. How are physicians reimbursed for 66985 and 66986?
  7. How are facilities reimbursed for 66985 and 66986?
  8. If coverage is unlikely or uncertain, how should we proceed?
  9. If the patient is paying for a refractive procedure, must we still file a claim to Medicare?
  10. What do we do if our claim is improperly denied?
  11. What are the options for pseudophakic patients who desire improved reading?
  12. When the procedure is considered refractive, are the fees limited to Medicare’s allowable or limiting charges?
  13. If the surgeon owns the ASC, must we segregate the ASC charges from the surgeon’s fees?

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