CMS approves $50 added fee for new IOL

Bill patient after subtracting normal lens allowance

The Centers for Medicare & Medicaid Services (CMS) has announced the approval of a new class of New Technology Intraocular Lenses (NTIOL) that is eligible for an additional $50 payment when the lens is provided in a surgery center. The payment adjustment is in effect Feb. 27, 2006, and is valid for five years.

CMS approved a request from Advanced Medical Optics that Tecnis Models Z9000, Z9001, and ZA9003 be given NTIOL status. Advanced Medical Optics provided data that the Tecnis IOL compensates for corneal spherical aberrations and improves vision, according to CMS. The new class of NTIOLs is referred to as Reduced Spherical Aberration.

Medicare suggests that surgery providers use a written notice to notify patients that the eyeglass/ contact replacement part is excluded from Medicare and, thus, the patient will be billed for that amount. The normal lens allowance should be subtracted from the charge, or it is considered a form of double billing. Medicare pays for the IOL as part of the facility fee.

Since the NTIOL process began in 1999, CMS has approved two NTIOL classes. The Multifocal Corrective IOLs and Toric classes were created in 2000 and expired in 2005. CMS stopped paying the additional $50 NTIOL payment for these classes in May 2005.

[Editor’s note: For more information, go to www.cms.hhs.gov/apps/media/press/release.asp?Counter=1762. The notice was published in the Federal Register on Jan. 27, 2006. To access that notice, go to www.gpoaccess.gov/fr/index.html. For more information, contact Michael Lyman at CMS. Telephone: (410) 786-6938.]