Hydrophilic Contact Lenses

80.4 - Hydrophilic Contact Lenses (Rev. 173, Issued: 09-04-14, Effective: Upon Implementation: of ICD-10, Implementation: Upon Implementation of ICD-10) Hydrophilic contact lenses are eyeglasses within the meaning of the exclusion in §1862(a)(7) of the Social Security Act and are not covered when used in the treatment of non-diseased eyes with spherical ametrophia, refractive astigmatism, and/or corneal astigmatism. Payment may be made under the prosthetic device benefit, however, for hydrophilic contact lenses when prescribed for an aphakic patient. A/B MACs are authorized to accept a Food and Drug Administration (FDA) letter of approval or other FDA-published material as evidence of FDA approval. (See §80.1 for coverage of a hydrophilic lens as a corneal bandage.) Cross-references: The Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services,” §100 and §120. The Medicare Benefit Policy Manual, Chapter 16, “General Exclusions from Coverage,” §20 and §90.