Accommodative Intraocular Lenses After Cataract Removal
|Effective Date:||August 15, 2019|
|Last Reviewed:||September 06, 2019|
This policy is to provide direction on correct billing for intraocular lenses (IOL) following cataract surgery.
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)
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.
|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.
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.