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CODING & BILLING
Stephanie Ellis, RN, CPC
How to Bill for Premium IOLs
Medicare has strict rules about billing patients for the difference.
W
hen a
Medicare
cataract patient
requests a premium
intraocular lens
instead of a standard IOL, Medicare
lets you charge him
the difference
between what
$1,000 OUT OF POCKET Medicare allows you only a modest markup of $25 to $50
above the IOL cost for the handling of premium IOLs.
Medicare reimburs-
Here's how to correctly charge a Medicare patient for a premium IOL.
es for use of a regu-
Premium lens cost
Medicare reimbursement for regular IOL
lar IOL ($150) and
the actual lens cost.
Surgical facility's cost for handling of IOL
Final suggested maximum amount you can charge patient
$1,100
- $150
$950
+ $50
$1,000
But billing patients for the difference, surgical centers must follow
certain rules to stay in compliance with Medicare guidelines. Here's
what you need to know.
Premium lens special rules
These premium lenses — CrystaLens, ReSTOR and ReZoom presbyopia-correcting lenses and the toric astigmatism-correcting IOL — are
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