CMS Pub. 100-04, ch. 14, § 40.3

Prior to January 1, 2008, payment for facility services furnished by an ASC for IOL

insertion during or subsequent to cataract surgery includes an allowance for the lens. The

procedures that include insertion of an IOL are:

Payment Group 6: CPT-4 Codes 66985 and 66986

Payment Group 8: CPT-4 Codes 66982, 66983 and 66984

Physicians or suppliers are not paid for an IOL furnished to a beneficiary in an ASC after

July 1, 1988. Separate claims for IOLs furnished to ASC patients beginning March 12,

1990, are denied. Also, effective March 12, 1990, procedures 66983 and 66984 are

treated as single procedures for payment purposes.

Beginning January 1, 2008, the Medicare payment for the IOL is included in the

Medicare ASC payment for the associated surgical procedure. Consequently, no separate

payment for the IOL is made, except for a payment adjustment for NTIOLs established

according to the process outlined in 42 CFR 416.185. ASCs should not report separate

charges for conventional IOLs because their payment is included in the Medicare

payment for the associated surgical procedure. The ASC payment system logic that

excluded $150 for IOLs for purposes of the multiple surgery reduction in cases of

cataract surgery prior to January 1, 2008, no longer applies, effective for dates of service

on or after January 1, 2008.

Effective for dates of service on and after February 27, 2006, through February 26, 2011,

Medicare pays an additional $50 for specified Category 3 NTIOLs that are provided in

association with a covered ASC surgical procedure. The list of Category 3 NTIOLS is

available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/ASCPayment/NTIOLs.html

ASCs should use HCPCS code Q1003 to bill for a Category 3 NTIOL. HCPCS code

Q1003, along with one of the approved surgical procedure codes (CPT codes 66982,

66983, 66984, 66985, 66986) are to be used on all NTIOL Category 3 claims associated

with reduced spherical aberration from February 27, 2006, through February 26, 2011.

The payment adjustment for the NTIOL is subject to beneficiary coinsurance but is not

wage-adjusted.

Any subsequent IOL recognized by CMS as having the same characteristics as the first

NTIOL recognized by CMS for a payment adjustment as a Category III NTIOL (those of

reduced spherical aberration) will receive the same adjustment for the remainder of the 5-year period established by the first recognized IOL.