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CODING & BILLING
of the cataract CPT code. You must subtract that amount from the
amount you charge the patient for the premium lens. Medicare allows
you only a modest markup of $25 to $50 above the IOL cost for handling
on premium IOLs. We break down the math on the preceding page.
Setting patients straight
If you want to indicate on your Medicare claim form that you used a
premium IOL in the cataract procedure, bill the premium lenses using
code V2787 for a toric astigmatism-correcting lens or code V2788 for
presbyopia-correcting IOLs (CrystaLens, ReSTOR and ReZoom) with
the –GY Non-Covered Modifier and/or the –GA Modifier appended to
the V-code to indicate the patient has signed an Advanced Beneficiary
Notice (ABN form or waiver). Because Medicare never covers the premium IOLs, you don't have to have Medicare patients sign an ABN.
Still, it's a good idea to have them do so. This way, there'll be no misunderstandings with patients on what they'll owe you for these lenses.
It's also a good idea to check out your internal policy on the use of
premium lenses in your cataract cases and make sure that you and
your cataract surgeons won't get in trouble on this issue with
Medicare. OSM
Ms. Ellis (sellis@ellismedical.com) is president of Ellis Medical Consulting, a
healthcare consulting firm in Nashville, Tenn.
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