CMS site answers accommodative IOL FAQs

Washington, DC-Ophthalmologists whose patients choose a presbyopia-correcting IOL following cataract surgery do not need to have the Medicare beneficiary sign a waiver or advanced beneficiary notice (ABN) prior to surgery.

Washington, DC-Ophthalmologists whose patients choose a presbyopia-correcting IOL following cataract surgery do not need to have the Medicare beneficiary sign a waiver or advanced beneficiary notice (ABN) prior to surgery.

The explanation was posted on the Centers for Medicare and Medicaid Services (CMS) Web site, along with answers to other frequently asked questions about Medicare and these IOLs.

The answers were compiled by the American Society of Cataract and Refractive Surgery (ASCRS) and CMS after many ophthalmologists requested clarification on the policy.

According to the explanations offered, a beneficiary does not need a waiver or ABN because there is no decision made as to whether the IOL is medically "reasonable and necessary." However, a practice might choose to offer a Notice of Exclusion of Medicare Benefit (NEMB) to clarify that the patient-and not Medicare- is responsible for additional costs associated with the presbyopia-correcting IOL. The NEMB is available on the CMS Web site at http://cms.hhs.gov/medicare/bni/20007_English.pdf.

The FAQ answer also explains that each medical facility may determine the amount it charges patients for implanting the accommodative IOL, because Medicare will not determine "standard and customary" charges for a non-covered service.

"The ASC may charge the beneficiary for any additional costs associated with insertion of the presbyopia-correcting IOL," the answer states.

In addition, CMS clarifies that it will pay for one pair of eyeglasses or contact lenses following cataract surgery, even if the beneficiary chooses an accommodative IOL.

More information is available from the Web site at http:// http://tinyurl.com/nrtru/.