Whether you are the patient or the care provider, the process of billing glasses after cataract surgery might be a puzzle. Medicare coverage can change over time, and costs vary depending on the health insurance company, the supplier, and the type of glasses the patient requires.
In this article, we aim to shed some light on how to bill glasses after cataract surgery, including information on what Medicare covers, stipulations for Medicare-approved post-cataract glasses and contact lenses, and costs for patients with Medicare Part A, B, or C. Then check out how Weave Payments can streamline your billing process and delight patients.
Watch the free webinar below to learn how to start streamlining your billing today:
Are Glasses Covered After Cataract Surgery?
Although Medicare typically doesn’t cover vision services like a routine eye exam or prescription glasses, surgery for cataracts is an exception. Medicare covers all or a portion of new eyeglasses since a new prescription is necessary after the surgery. The vision coverage doesn’t include add-ons like tinting, special coatings, or progressive lenses.
The amount Medicare covers for a patient’s glasses depends on whether they received an intraocular cataract lens (IOL) implant. Medicare guidelines state that the patient’s policy covers one pair of glasses or contacts after an IOL insertion surgery, meaning they could obtain an additional pair after surgery on their second eye.¹ Read on to learn how to bill glasses after cataract surgery.
How To Get Free Glasses After Cataract Surgery
If the patient has Medicare, Medicare Advantage plan (Medicare Part C), or Medicaid services coverage, they might be able to receive new glasses for free after surgery. Medicare Part B coverage handles the cost of glasses in many Medicare insurance plans.
Most policies also offer durable medical equipment (DME) to patients post-surgery, including wheelchairs and eyeglasses, through a third-party DME Medicare Administrative Contractor (DME MAC). The patient’s healthcare provider will contact their Medicare insurance agency to request coverage as stipulated by their health insurance benefits.
What Is the Medicare-Approved Amount for Glasses After Cataract Surgery?
The Medicare-approved amount refers to the amount the supplier of the glasses receives, which might be less than the amount the supplier charges. The patient is responsible for paying the difference if a disparity exists between the Medicare-approved amount and the supplier’s charge.
The patient has to pay the costs of any non-covered add-ons, and only eyeglasses from a Medicare-enrolled supplier are eligible for coverage. Besides extras, the patient must pay the surgery cost, the Medicare Part B deductible of $233 in 2022, the monthly premium, and 20% of the Medicare-approved amount.²
Will Medicare Reimburse for Glasses After Cataract Surgery?
Whether or not Medicare or Medicare Advantage will reimburse a patient for glasses after traditional or laser cataract surgery—and how much they will have to pay—depends on several factors, including:
- The types of insurance policies the patient holds
- How much the supplier charges for the glasses and add-ons (if any)
- The type of facility and whether it is a Medicare-enrolled supplier
- The location where the patient receives the eye exam and other vision-care services
To be eligible for coverage, the patient must have received an intraocular lens during cataract surgery. If they want more than post-cataract eyeglasses, the patient will need to self-pay the extra costs for upgrades. While the healthcare provider can recommend additional services or add-ons, they should ensure that the patient understands what original Medicare and Medicare Advantage do and don’t cover.
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How Medicare Bills Post-Cataract Glasses
When billing for glasses after cataract extraction and IOL, keep in mind that the Medicare plan covers one pair of glasses or contact lenses after each surgery. It’s also important to look into local coverage determinations (LCDs) to ensure that you don’t miss any policy requirements.
An example of an LCD stipulation states that if a patient receives two separate surgeries on each eye but doesn’t receive glasses or contact lenses between the surgeries, Medicare will only cover one pair of post-surgery glasses or lenses.
The following are diagnosis codes to report for post-cataract glasses:
- Pseudophakia: Z96.1
- Aphakia: H27.01, H27.02, and H27.03
- Congenital aphakia: Q12.3
Be sure to bill the correct healthcare procedure code (V21xx, V22xx, etc.). Your claims should go to your DME MAC when billing for a glass or contact lens after surgery.
How To Make Billing and Patient Communication Easy
Weave is an all-in-one communication software that seamlessly integrates with your practice to provide an effortless and organized tool for staying in touch with your patients. Instead of relying on several systems for your phones, payments, schedules, etc., Weave offers a way to handle everything in one place.
Since Weave will make everything effortlessly manageable, you’ll get more positive reviews, faster payments, easier scheduling, and much more. Get a demo today and find out how Weave can accelerate your business.
Do people wear temporary glasses after cataract surgery?
Directly after surgery, the patient’s vision will be blurry. After a week, they should have clear vision in the operated-upon eye but might have very different prescriptions for each eye. Temporary reading glasses can help patients read during this post-op adjustment period if their regular prescription eyeglasses are too uncomfortable to wear or they experience tunnel vision.³
What should I know about progressive glasses after cataract surgery?
Before deciding how to bill glasses after cataract surgery, the patient needs to discuss their eye health and vision post-surgery with their cataract surgeon.
If the patient chooses a single vision IOL, they can use progressive glasses to compensate for near or far-sightedness. Multifocal IOLs make corrective lenses unnecessary, but some patients are unhappy with the results of their vision with multifocal lenses.4