US · guidance
CMS Pub. 100-04, ch. 32, § 120.4
Beneficiary Liability
When a beneficiary requests insertion of a P-C or A-C IOL instead of a conventional IOL following removal
of a cataract and that procedure is performed, the beneficiary is responsible for payment of facility and
physician charges for services and supplies attributable to the P-C or A-C functionality of the P-C or A-C
IOL:
• In determining the beneficiary's liability, the facility and physician may take into account any
additional work and resources required for insertion, fitting, vision acuity testing, and monitoring of
the P-C or A-C IOL that exceed the work and resources attributable to insertion of a conventional IOL.
The physician and the facility may not charge for cataract extraction with insertion of a P-C or A-C
IOL unless the beneficiary requests this service.
o The physician and the facility may not require the beneficiary to request a P-C or A-C IOL as a
condition of performing a cataract extraction with IOL insertion.
History
(Rev. 1228; Issued: 04-27-07; Effective: 01-22-07; Implementation: 05-29-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
0d9d3b0a28a4710622d2ff6b07104be6416d8e91775c32f7a2055fd45291e9ca
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