Ophthalmology and Optometry Coding Alert

Medicare will pay extra for the new-technology IOLs for the next 5 years

Ambulatory surgery centers using Tecnis intraocular lenses for their cataract surgery patients can expect an extra $50 now that Medicare has approved the lenses as new-technology IOLs (NTIOL).
 
Starting Feb. 26, 2006, ASCs can claim the extra payment with HCPCS code Q1003 (New technology intraocular lens category 3 as defined in Federal Register notice) submitted along with the facility's portion of the cataract extraction code.
 
Medicare will deny any Q1003 claim without a cataract extraction code (66982-66986). Carriers will also deny payment for Q1003 if billed by an entity other than a Medicare-approved ASC.
 
ASCs should append modifier SG (Ambulatory surgical center facility service) to the cataract code to differentiate it from the physician's services. Payment to the ASC for the IOL itself is included in 6698x-SG, says Kathleen Sellers, CPC, OCS, coding and reimbursement manager at the Maine Eye Center in Portland.
 
Tecnis IOL model numbers Z9000, Z9001 and ZA9003 will be eligible for the $50 premium for five years, until Feb. 26, 2011.
 
The manufacturer, Advanced Medical Optics, applied for NTIOL status, providing evidence that the Tecnis lens compensates for corneal spherical aberrations and improves vision. CMS created NTIOL category 3, called "Reduced Spherical Aberration." 
 
The Tecnis IOLs are the only NTIOLs now available, but any other IOLs with the same characteristics that Medicare approves for category 3 will also be eligible for the $50 premium until 2011.
 
Previously, Medicare created NTIOL categories 1 and 2 (Q1001 and Q1002), but the reimbursement period for those codes ended in 2005 and the IOLs in those categories are no longer considered "new technology." The codes have been deleted from the 2006 HCPCS book.
 
For more information, download Medicare Transmittal 914 from www.cms.hhs.gov/transmittals/downloads/R914CP.pdf.