Medicare National Coverage Determinations (NCD) Manual (Pub. 100-03), Ch. 1 § 80.1
Hydrophilic Contact Lens for Corneal Bandage
80.1 - Hydrophilic Contact Lens for Corneal Bandage
(Rev. 173, Issued: 09-04-14, Effective: Upon Implementation: of ICD-10,
Implementation: Upon Implementation of ICD-10)
Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of
acute or chronic corneal pathology, such as bulbous keratopathy, dry eyes, corneal ulcers
and erosion, keratitis, corneal edema, descemetocele, corneal ectasis, Mooren’s ulcer,
anterior corneal dystrophy, neurotrophic keratoconjunctivitis, and for other therapeutic
reasons.
Payment may be made under §1861(s)(2) of the Social Security Act for a hydrophilic
contact lens approved by the Food and Drug Administration (FDA) and used as a supply
incident to a physician’s service. Payment for the lens is included in the payment for the
physician’s service to which the lens is incident. A/B MACs are authorized to accept an
FDA letter of approval or other FDA published material as evidence of FDA approval.
(See §80.4 for coverage of a hydrophilic contact lens as a prosthetic device.) See the
Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health
Services,” and the Medicare Benefit Policy Manual, Chapter 6, “Hospital Services
Covered Under Part B,” §20.4.