Medicare Guidelines for Laser-Assisted Cataract Surgery Billing
                     Medicare Guidelines for Laser-
Assisted Cataract Surgery Billing
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Medicare Guidelines for Laser-
Assisted Cataract Surgery Billing
To avoid any error while billing for laser-assisted cataract surgery. 
As per CMS Ruling 05-01, Medicare will allow beneficiaries to pay 
additional charges associated with insertion of a presbyopia 
correcting intraocular lens (PC-IOL) following cataract surgery. As 
per CMS-Ruling 1536-R, effective for services on and after January 
22, 2007, Medicare will allow beneficiaries to pay additional 
charges for insertion of an astigmatism correcting intraocular lens 
(TAhCe-IsOeL r)u. lings allow the beneficiary to pay additional charges for 
two specific categories of non-covered services:
● The portion of the facility charge for the PC-IOL or AC-IOL that 
exceeds the facility charge for insertion of a conventional 
intraocular lens (IOL) following cataract surgery.
● Physician charges for resources required for fitting and vision 
acuity testing of a PCIOL or AC-IOL that exceeds the facility or 
physician charges for resources furnished for a conventional 
IOL following cataract surgery.
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Medicare Guidelines for Laser-
Assisted Cataract Surgery 
Billing
➢ These rulings allow facilities and physicians to charge 
patients only for the non-covered portion of a service that is 
furnished at the same time as a covered service. 
➢ Services that are part of cataract surgery with 
● a conventional lens, including but 
not necessarily limited to the 
incision by whatever method, 
● capsulotomy by whatever method 
● lens fragmentation by whatever 
method, may not be charged to the 
➢ The bepnaetifiecnita.r y may only be charged for those non-
covered services specified above.
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Medicare Guidelines for Laser-
Assisted Cataract Surgery 
Billing
We are providing this guidance because of a recent press release 
from an ophthalmology practice that described use of bladeless, 
computer-controlled laser surgery for cataract removal.The press 
release may imply a different Medicare policy regarding non-
covered services that may be charged to the beneficiary if the 
cataract surgery is performed using a bladeless, computer-
The press release stcaontetrsol:l ed laser. 
● While traditional cataract surgery is fully covered by most private 
medical insurance and Medicare, bladeless cataract surgery requires 
patients to pay out-of-pocket for the portion of the procedure that 
insurance does not cover. 
● Medicare coverage and payment for cataract surgery is the same 
irrespective of whether the surgery is performed using conventional 
surgical techniques or a bladeless, computer controlled laser. 
● Under either method, Medicare will cover and pay for the cataract 
removal and insertion of a conventional intraocular lens.
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Medicare Guidelines for Laser-
Assisted Cataract Surgery Billing
● If the bladeless, computer controlled laser cataract surgery 
includes implantation of a PC-IOL or AC-IOL, only charges for 
those non-covered services specified above may be charged to 
the beneficiary. 
● These charges could possibly include charges for additional 
services, such as imaging, necessary to implant a PC-IOL or an 
AC-IOL but that are not performed when a conventional IOL is 
Peimrfpolarmntaedn.ce of such additional services by a physician on a 
limited and non-routine basis in conventional IOL cataract 
surgery would not disqualify such services as non-covered 
services. This guidance does not apply to the use of 
technology for refractive keratoplasty.
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Medicare Guidelines forH LTaTsPeSr:-//AWsWsiWst.MedE DCISaYtaSrDaAcTt AS.CuOrgMe/ry Billing (medisysdata.com)
Medicare Guidelines for Laser-
Assisted Cataract Surgery Billing
 
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