This policy is consistent with Medicare's coverage determination. The Company's payment methodology may differ from Medicare.
Subject to the terms and conditions of the applicable Evidence of Coverage, conventional intraocular lenses IOLs inserted following removal of a cataract are covered under the medical benefits of the Company's Medicare Advantage products.
Subject to the applicable Evidence of Coverage Presbyopia-correcting, astigmatism-correcting, and new technology IOLs are not eligible for payment under the medical benefits of the Company's Medicare Advantage products because the service is considered not covered.
For individuals receiving a presbyopia- or astigmatism-correcting IOL, the member is not responsible for the cost of the conventional IOL or the surgical procedure for insertion of the lens. However, the member is financially responsible for the portion of the charge for the presbyopia-correcting or astigmatism-correcting IOL that exceeds the charge for a conventional IOL. Member reimbursement requires the submission of a paid receipt or invoice, along with the specific claim form used to process this type of service. This claim form can be obtained by contacting Member Services or through the Company website.
For individuals who receive a conventional IOL, professional providers should report the appropriate Healthcare Common Procedural Coding System (HCPCS) code for the conventional IOL: V2630, V2631, or V2632.
For individuals who receive the presbyopia-correcting IOL, professional providers should report V2788. For individuals who receive the astigmatism-correcting IOL, providers should report V2787. For individuals who receive an NTIOL, outpatient facilities should report HCPCS code C1780.
Professional providers and/or outpatient facilities should report the appropriate Healthcare Common Procedural Coding System code that represents the insertion of conventional, presbyopia-correcting, astigmatism-correct or new technology intraocular lens.