Private Insurance
Reimbursement for Cataract Surgery.
With a full range of vision and the potential for freedom from glasses, the AcrySof® IQ ReSTOR® IOL will be an appealing option for many of your patients. In order to offer them the best possibility for better quality vision and increased spectacle freedom, it’s important to understand the issues regarding reimbursement for cataract surgery through both Medicare and private insurers.
Medicare Coverage
In May of 2005, the Centers for Medicare and Medicaid Services (CMS) clarified their payment rules to offer Medicare beneficiaries the option to select presbyopia-correcting intraocular lenses (IOLs).
Prior to the CMS ruling, Medicare limitations prevented beneficiaries from choosing to purchase these lenses. Under the new policy, Medicare will continue to pay existing reimbursement amounts for cataract surgery, and patients may elect to pay additional charges for advanced technology lenses such as the AcrySof® IQ ReSTOR® IOL.
Learn more about Medicare coverage at Alcon.com.
Private Insurance
Before your privately insured patients consider surgery with the AcrySof® IQ ReSTOR® IOL, it’s important to help them understand which services will be covered. Your patients deserve to be fully educated on the surgical procedure and how your services will be billed.
Communication with the insurance providers is also important, as you will need authorization to bill the patient for services not covered by their insurance. Inform your administrative personnel to handle charges and payments according to each patient’s coverage, instructing them to use appropriate CPT and HCPCS codes to identify and distinguish items that are covered.
In some cases, patients may wish to have the AcrySof® IQ ReSTOR® IOL implanted, even though their cataracts may not meet the criteria for the procedure under their plan's coverage. These cases are subject to unique rules and regulations.
For more information regarding private coverage, download this Elective Intraocular Lens Reimbursement Guide from Alcon Reimbursement Services.
