Ophthalmology and Optometry Coding Alert

Question: Can you explain when it is and is not appropriate to charge for the use of FS laser in the treatment of cataracts?

Iowa Subscriber

Answer: Medicare Part B covers cataract surgery and conventional intraocular lens (IOL) implantation without regard to the technology used. The allowable reimbursement for cataract surgery does not change according to the surgical methods used — it is the same whether a cystotome or femtosecond (FS) laser makes the capsulotomy.

If the ophthalmic surgeon uses the laser for cataract surgery and the patient gets a standard lens, you cannot charge for the laser. Neither the physician nor the facility may obtain additional reimbursement from either Medicare or the patient over and above the Medicare-allowable amount. It is not appropriate to “balance bill” the patient or their secondary insurer for any additional fees to perform covered components of cataract surgery with an FS laser.

However, you can bill patients for the use of an FS-laser when used for refractive incisions (limbal relaxing incisions (LRIs) or astigmatic keratotomy (AK)) to address astigmatism.

Keep in mind: The patient must be informed about, and consent to, the additional out-of-pocket costs in advance.