# billing medicare for lens



## KELLI (Oct 21, 2010)

I need some assistance/confirmation from you both on how to properly bill for the Alcon Toric IOL.  This lens in particular was deemed an NTIOL by Medicare in August 2009, which Medicare pays an additional  $50 (billed as HCPCS code Q1003) to the ASC.  The question is when we bill the for the incremental portion of our cost less the $150 that is included as part of 66982 or 66984, do we then subtract the $50 NTIOL or not???

Following is an example of how an article states how to correctly charge a Medicare patient for a Toric lens: 

  $500 Approximate cost of the Toric lens to the facility 
-$150 Medicare reimbursement for regular IOL as part of cataract CPT code 
-  $50 Extra $50 that Medicare reimburses for the use of an NTIOL with code Q1003 
  $300 
+  $50 ASC's cost for shipping and handling of lens ($50 maximum) 
– Modest mark-up 
  $350 Final suggested maximum amount ASC can charge a Medicare patient 

Here is the link to the entire article:
http://www.hcpro.com/HOM-239313-816...or-which-ASCs-can-bill-patients-directly.html

This is how we have been billing:

$495 Cost of the Toric lens
-$150 Medicare reimbursement for regular IOL as part of cataract CPT code
$345
+$15 ASC's cost for shipping and handling
$360 Amount billed to physician (on behalf of patient)


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