Reimbursements

Category:

Accommodative Intraocular Lenses After Cataract Removal

Reimbursement Policy: NDRP-GC-020
Topic: Surgery
Effective Date: August 15, 2019
Last Reviewed: September 06, 2019

Description:

This policy is to provide direction on correct billing for intraocular lenses (IOL) following cataract surgery.

Definitions:

Three types of intraocular lenses (IOL) are used following cataract surgery:

  • Standard or conventional lens
  • Astigmatism-correcting intraocular lens (A-C-IOL)
  • Presbyopia-correcting intraocular lens (P-C-IOL)

Policy:

The allowance for the standard or conventional IOL is included in the hospital outpatient facility fee schedule and the Ambulatory Surgical Center (ASC) surgical fee schedule amount for cataract surgery. If a member chooses to have the accommodative IOL implanted during cataract surgery, the charge for the accommodative lens above the charge for the standard IOL is the member’s responsibility.

Blue Cross Blue Shield of North Dakota (BCBSND) will require the specific IOL HCPCS codes below to be billed on revenue code 0276 (Intraocular Lens). The charges billed for the accommodative IOL HCPCS code must be the difference between the accommodative IOL and the standard IOL charge. The amount billed on revenue code 0276 will be rejected as member liable.

HCPCS Description
C1780 Lens, intraocular (new technology)
Q1004 New technology, intraocular lens, category 4 as defined in Federal Register notice
Q1005 New technology, intraocular lens, category 5 as defined in Federal Register notice
V2630 Anterior chamber intraocular lens
V2631 Iris supported intraocular lens
V2632 Posterior chamber intraocular lens
V2787 Astigmatism correcting function of intraocular lens
V2788 Presbyopia correcting function of intraocular lens
S0596 Phakic intraocular lens for correction of refractive error

Note: C-codes are institutional only.

Any charges reflecting the cost of the standard lens should not be member liable and therefore should not be included in the amount billed for the accommodative IOL HCPCS. The rate for the cataract surgery includes payment for the standard IOL.

Cross Reference:

NDBCBS Medical Policy – Intraocular Lens

Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.