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Medicare patients can choose presbyopia-correcting IOLs

Ambulatory Surgery Reimbursement Update, May 17, 2005

The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare beneficiaries can now request insertion of presbyopia-correcting Intraocular lenses (IOLs) following cataract surgery.

The rule, issued May 3, allows patients to request these IOLs in place of conventional IOLs with the understanding that they will be responsible for the costs of using presbyopia-correcting IOLs and the services needed to insert the lenses that exceed the charge for insertion of a conventional IOL.

Prior to this ruling, "beneficiaries were essentially precluded from receiving these lenses because technology costs significantly exceeded Medicare payment amounts," according to a statement issued by the American Association of Ambulatory Surgery Centers (AAASC).

"This medical device is tremendous new technology," says Craig Jeffries, executive director of the AAASC. "The price that Medicare traditionally has paid is much lower than the cost that the surgery center has to pay.

"Instead of increasing the amount that Medicare is going to pay for this new device, (CMS has) basically recategorized it, said that it's not an essential Medicare covered service, but we do recognize that beneficiaries want it and therefore we've created this brand new mechanism to allow them to get the Medicare benefit but pay extra for their deluxe benefit," says Jeffries.

To view CMS's announcement, click here.

To view the ruling, click here (Adobe Acrobat required).

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