CMS Pub. 100-04, ch. 32, § 120.3

When a beneficiary requests insertion of a P-C or A-C IOL instead of a conventional IOL following removal

of a cataract:

• Prior to the procedure to remove a cataractous lens and insert a P-C or A-C lens, the facility and the

physician must inform the beneficiary that Medicare will not make payment for services that are

specific to the insertion, adjustment or other subsequent treatments related to the P-C or A-C

functionality of the IOL.

• The P-C or A-C functionality of a P-C or A-C IOL does not fall into a Medicare benefit category, and,

therefore, is not covered. Therefore, the facility and physician are not required to provide an

Advanced Beneficiary Notice to beneficiaries who request a P-C or A-C IOL.

• Although not required, CMS strongly encourages facilities and physicians to issue a Notice of

Exclusion from Medicare Benefits to beneficiaries in order to clearly identify the non-payable aspects

of a P-C or A-C IOL insertion. This notice may be found in English at

http:\\cms.hhs.gov/medicare/bni/20007_English.pdf

• Spanish language at: http://cms.hhs.gov/medicare/bni/20007_Spanish.pdf.