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Topic: Understand the billing methods for different types of lenses

Ambulatory Surgery Reimbursement Update, November 18, 2008

Billing for lenses when patients have cataract surgery is generally straightforward. Coders most commonly assign CPT code 66984 to report a basic cataract surgery. The national Medicare physician payment for CPT code 66984 is $626.15, which includes the cost for the standard monofocal lens (typically $150). However, coders often fail to recognize the difference between the various lenses and don’t make the necessary distinction between what is truly a new-technology intraocular lens (NTIOL) and what is considered a two-aspect or refractive-correcting lens.

CMS has listed only a handful of lenses that qualify as NTIOLs. Consider the following manufacturers and models:

• AMO—Tecnis Z9000, Z9001, Z9002, ZA9003, AR40xEM, Tecnis 1-Piece IOL ZCB00
• Alcon—AcrySof IQ SN60WF, Acrysert Delivery System Model SN60WS
• Bausch& Lomb—Sofport LI61AO, LI61AOV
• STAAR—Affinity Collamer CQ2015A, CC4204A, Elastimide AQ2015A

When billing for new-technology lenses, coders should report HCPCS code Q1003. Medicare will pay ASCs an extra $50 for NTIOLs. However, this is a Medicare-only program, so commercial payers might follow a different payment program and pay a different amount, says Allison Shuren, Esq., partner at Arnold & Porter, LLP, in Washington, DC. In these cases, the patient is responsible for his or her copays and deductibles only, Shuren says.

Medicare has agreed to pay this additional $50 to ASCs for NTIOLs until Feb. 26, 2011. It is also important for coders to report the correct model numbers when they bill for NTIOLs.

Editor’s note: This topic is from the October 2008 issue of Ambulatory Surgery Coding and Reimbursement Insider.

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