Payment for Intraocular Lens (IOL)

40.3 - Payment for Intraocular Lens (IOL) (Rev. 11793; Issued:01-19-23; Effective: 02-21-23; Implementation: 02-21-23) Prior to January 1, 2008, payment for facility services furnished by an ASC for IOL insertion during or subsequent to cataract surgery includes an allowance for the lens. The procedures that include insertion of an IOL are: Payment Group 6: CPT-4 Codes 66985 and 66986 Payment Group 8: CPT-4 Codes 66982, 66983 and 66984 Physicians or suppliers are not paid for an IOL furnished to a beneficiary in an ASC after July 1, 1988. Separate claims for IOLs furnished to ASC patients beginning March 12, 1990, are denied. Also, effective March 12, 1990, procedures 66983 and 66984 are treated as single procedures for payment purposes. Beginning January 1, 2008, the Medicare payment for the IOL is included in the Medicare ASC payment for the associated surgical procedure. Consequently, no separate payment for the IOL is made, except for a payment adjustment for NTIOLs established according to the process outlined in 42 CFR 416.185. ASCs should not report separate charges for conventional IOLs because their payment is included in the Medicare payment for the associated surgical procedure. The ASC payment system logic that excluded $150 for IOLs for purposes of the multiple surgery reduction in cases of cataract surgery prior to January 1, 2008, no longer applies, effective for dates of service on or after January 1, 2008. Effective for dates of service on and after February 27, 2006, through February 26, 2011, Medicare pays an additional $50 for specified Category 3 NTIOLs that are provided in association with a covered ASC surgical procedure. The list of Category 3 NTIOLS is available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/ASCPayment/NTIOLs.html ASCs should use HCPCS code Q1003 to bill for a Category 3 NTIOL. HCPCS code Q1003, along with one of the approved surgical procedure codes (CPT codes 66982, 66983, 66984, 66985, 66986) are to be used on all NTIOL Category 3 claims associated with reduced spherical aberration from February 27, 2006, through February 26, 2011. The payment adjustment for the NTIOL is subject to beneficiary coinsurance but is not wage-adjusted. Any subsequent IOL recognized by CMS as having the same characteristics as the first NTIOL recognized by CMS for a payment adjustment as a Category III NTIOL (those of reduced spherical aberration) will receive the same adjustment for the remainder of the 5- year period established by the first recognized IOL.