Ophthalmology and Optometry Coding Alert

Question: If we have an ambulatory surgical center (ASC), how can we get paid for intraocular lens (IOL) supply when doing cataract surgery?

Connecticut Subscriber

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Answer: The supply of the IOL in an ASC setting is included in the facility fee for Medicare billing. You cannot be paid extra for the supply.

However, if the IOL lens is one of the new technology IOLs (NTIOLs), an additional $50 may be billed and paid. The codes for NTIOLs are Q1001 (new technology intraocular lens category 1 as defined in Federal Register notice, Vol. 65, date May 3, 2000) and Q1002 (new technology intraocular lens category 2 as defined in Federal Register notice, Vol. 65, dated May 3, 2000). When billing Medicare for the procedure performed with NTIOLs, use 66983-66986 on the first line of the HCFA 1500 form, and either Q1001 or Q1002 on the second line.

When billing private payers for the supply of an IOL, use 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), which is a catchall code for supplies and materials. Describe the IOL inserted and be prepared to supply a copy of the invoice for the IOL that shows your cost for the material if requested. Do not use HCPCS codes to bill private payers.