WASHINGTON — The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery have issued guidelines on billing Medicare or its beneficiaries for the use of femtosecond lasers in cataract procedures, the organizations announced in a joint news release.
According to the guidelines, providers may not bill Medicare, beneficiaries or secondary insurers additional fees to perform medically necessary cataract extraction with implantation of a conventional IOL.
"Medicare Part B covers the cataract surgery and the implantation of a conventional IOL without regard to the technology used," the release said. "A surgeon may use the [femtosecond] laser for the cataract surgery, but neither the surgeon nor the facility may obtain additional reimbursement from either Medicare or the patient over and above the Medicare-allowable amount."
Surgeons should not use the differential charge allowed for presbyopic and toric IOLs to recover all or part of the costs of using a femtosecond laser in cataract removal.
Surgeons may charge additional fees for refractive lens exchange, which is not covered by Medicare, with appropriate informed consent.
The guidelines apply exclusively to the Medicare fee-for-service program and are subject to change based on future regulations issued by the Centers for Medicare and Medicaid Services or its contractors.
Ophthalmologists are directed to seek additional guidance from their Medicare carriers for coverage determinations under Medicare Part C or through commercial carriers, the release said.
The guidelines are available on the AAO site and ASCRS site.