Eye Care - Following Cataract Surgery Detailed
Coverage: Conditions that must be met before Medicare will provide coverage, and limits to coverage.
Following each cataract surgery with insertion of an intraocular lens, Medicare can help pay for one pair of conventional eyeglasses or contact lenses provided by a supplier that is authorized to provide such services in your state.
- Only standard frames are covered. (You may purchase upgraded frames, but you will be responsible for paying the difference between the Medicare-approved amount for the standard frames and the cost of the upgraded frames).
- Lenses are covered even if you had the surgery before you had Medicare.
- Payment may be made for lenses for both eyes even if the cataract surgery only involved one eye.
CoPayment: The amount you need to pay.
You pay 20% of the Medicare-approved amount for one pair of “standard frame” eyeglasses or contact lenses after each cataract surgery with an intraocular lens. If you choose to purchase “upgraded frames,” you will pay any additional expenses associated with the “upgraded frames.”
Medicare Part: The part of Medicare that pays for this service or supply.
Organization Name: The organization name that this coverage topic is associated with.
DMERC -- Durable Medical Equipment Regional Carrier
Important Notes: Details regarding important notes about the coverage.
You must pay an annual $100 deductible for Part B services and supplies before Medicare begins to pay its share. Actual amounts you must pay may be higher if a doctor, health care provider, or supplier does not accept assignment. If you choose to purchase “upgraded frames,” your supplier should ask you to sign an Advance Beneficiary Notice (ABN) informing you that you will be required to pay the difference in the cost for the “upgraded frames” and the Medicare-approved amount for “standard frames.” If you choose to purchase “upgraded frames,” your supplier is required to submit claims to Medicare indicating the purchase of the “upgraded frames” as 2 separate line items on the claim. The supplier will use code V2020 for the cost of the “standard frames” (the Medicare-approved amount) and code V2025 for the difference between the charges for the “deluxe frames” and the “standard frames” (the amount you are required to pay). These codes will appear on the Medicare Summary Notice (MSN) you receive. Code V2025 will appear on your MSN as a non-covered charge.