Intraocular Lens

Section: Orthotic & Prosthetic Devices
Effective Date: July 01, 2018
Revised Date: October 10, 2019
Last Reviewed: September 26, 2019

Description

An intraocular lens is a hard type of artificial lens which is surgically implanted in the eye to replace the natural crystalline lens.

Criteria

Pseudophakos Intraocular Lens

The intraocular lenses listed below are covered prosthetic devices and are processed under the applicable procedure codes, subject to benefit coverage:

  • Iris fixation lenses
  • Irido-capsular fixation lenses
  • Posterior chamber lenses
  • Anterior chamber angle fixation lenses

 

Procedure Codes

L8699V2630V2631V2632

The intraocular lenses listed below are not covered prosthetic devices, as their purpose is to avoid the need for glasses following cataract surgery. Corrective lenses provided solely for refractive error or to compensate for the imperfect curvature of the cornea (astigmatism) are not a standard benefit and are excluded from coverage.

If a member chooses to have a presbyopia or astigmatism-correcting intraocular lens following cataract surgery, the lens itself will be denied as non-covered.

  • Presbyopia-correcting intraocular lens (e.g., CrystaLens, RESTOR, ReZoom)
  • Astigmatism-correcting intraocular lens and Clear lens extraction intraocular lens

 

Procedure Codes

V2787V2788Q1004Q1005

Any additional pre-, and intra post-operative services beyond those typically provided in conjunction with a cataract extraction with insertion of a standard IOL will also be denied as non-covered.

Procedure Codes

0514T

Phakic intraocular lenses are not covered prosthetic devices, as their purpose is to avoid the need for glasses. They are not a standard benefit and are excluded from coverage.

  Procedure Codes

S0596

Ocular Telescopic Prosthesis including removal of Crystalline Lens is considered experimental/investigational.

Procedure Codes

0308T

When the presbyopia-correcting or astigmatism-correcting intraocular lens is inserted solely for the correction of refractive errors or to compensate for the imperfect curvature of the cornea (i.e., not for cataract surgery), the lens, the surgical procedure, and all pre- and post-operative care will deny as non-covered and will entirely be the member’s financial responsibility.

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