Medicare Reimbursement for Intraoperative Visual Axis Identification

During cataract surgery, the surgeon relies on anatomical markers for orientation, chiefly the pupil. In a normal eye, with monocular fixation under the operating microscope, the corneal light reflex that corresponds with the visual axis is displaced nasally about 0.5mm from the center of the pupil; this is known as positive angle kappa.

Patients vary and so does the degree and direction of the displacement. Intraoperative visual axis identification uses light reflected from the operating microscope to guide placement of the capsulor-rhexis and to center the intraocular lens (IOL) independent of the location of the dilated pupil.


This FAQ addresses the following:

  1.  What is intraoperative visual axis identification using patient fixation?
  2.  Why is it important?
  3.  How is it performed?
  4.  How is this service reported on a claim for reimbursement?
  5.  Does Medicare cover this service?
  6.  Is the patient financially responsible for any part of this service?
  7.  If coverage of visual axis identification is uncertain or doubtful, how should the surgeon proceed?


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