Co-Management of Cataract Surgery with Premium IOLs

Cataract surgery that includes implantation of a presbyopia-correcting IOL (P-C IOL) or astigmatism-correcting IOL (toric IOL) treats two conditions: one medical – cataract impairing vision, and the other refractive – presbyopia or astigmatism. Treatment of the medical condition is covered, while the refractive treatment is non-covered and payable by the patient. These lenses are frequently referred to as “premium” IOLs. For additional discussion of premium IOLs, please request our FAQ and/or monograph on the topic.

Co-management of these cases is permitted because Medicare’s guidelines for co-management of postsurgical care do not depend on the type of IOL used. Follow existing co-management protocols for the covered portion of these procedures.

This FAQ addresses the following:

  1. Is co-management permitted when patients undergo cataract surgery with premium IOLs?
  2. May the non-covered physician services be co-managed?
  3. What is included in the package of non-covered physician services?
  4. How is the value of this package determined?
  5. In a co-management situation how is the value of this package divided between the two physicians?
  6. May the surgeon collect a single fee for the noncovered services and pay the referring doctor for his services?
  7. Is the co-managing physician entitled to any part of the additional payment for the premium IOL?
  8. Who should obtain a financial waiver in reference to non-covered services?

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