CMS Pub. 100-04, ch. 32, § 120

Lenses (A-C IOLs) (General Policy Information)

(Rev. 1228; Issued: 04-27-07; Effective: 01-22-07; Implementation: 05-29-07)

Per CMS Ruling 05-01, issued May 3, 2005, Medicare will allow beneficiaries to pay additional charges

associated with insertion of a P-C IOL following cataract surgery.

• Presbyopia is a type of age-associated refractive error that results in progressive loss of the focusing

power of the lens of the eye, causing difficulty seeing objects at near distance, or close-up. Presbyopia

occurs as the natural lens of the eye becomes thicker and less flexible with age.

• A presbyopia-correcting IOL is indicated for primary implantation in the capsular bag of the eye for

the visual correction of aphakia (absence of the lens of the eye) following cataract extraction that is

intended to provide near, intermediate and distance vision without the need for eyeglasses or contact

lenses.

Per CMS-1536-Ruling, effective for services on and after January 22, 2007, Medicare will allow beneficiaries

to pay additional charges (which are non-covered by Medicare as these additional charges are not part of a

Medicare benefit category) for insertion of an A-C IOL.

• Regular astigmatism is a visual condition where part of an image is blurred due to uneven corneal

curvature. A normal cornea has the same curvature at all axes, whereas the curvature of an

astigmatic cornea differs in two primary axes, resulting in vision that is distorted at all distances.

• The A-C IOL is intended to provide what is otherwise achieved by two separate items; an

implantable conventional IOL (one that is not astigmatism-correcting) that is covered by Medicare,

and the surgical correction, eyeglasses or contact lenses that are not covered by Medicare.

A list of A-C IOLs and P-C IOLs can be accessed online at

http://www.cms.hhs.gov/HospitalOutpatientPPS/01_overview.asp