Management Considerations for Refractive Cataract Surgery Using Femtosecond Laser

Many patients ask, “Do you perform cataract surgery using a laser?”, and surgeons carefully explain the difference between primary cataracts and secondary cataracts, the myths about cataract, and the surgical procedures involved. While lasers have been used for posterior capsulotomy, soften cataracts, and speed up emulsification, phacoemulsification remains the favored technique in the developed world. Recently, several companies (e.g., Abbott, LensAR, LenSx, Technolas) have been developing femtosecond (FS) lasers for use in refractive cataract surgery with the goal of improving surgical precision and patient outcomes. Since cataract surgery is most often performed on the elderly, who are commonly enrolled in the Medicare program, this exciting new technology poses some serious challenges for billing and reimbursement; in particular, determining which services are reimbursed by Medicare and which are not.

This monograph describes how femtosecond (FS) lasers can be employed in the context of the longstanding coverage and payment policies of the Medicare program as well as most other third party payers for cataract and refractive surgery. We discuss the chronology of events associated with refractive cataract surgery using the FS laser, including planning the surgery, capsulorrhexis, fragmentation of the cataract, corneal incisions, and refractive corneal surgery. At each step, we consider how billing should be done.


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