This policy provides direction on correct billing for intraocular lenses (IOL) following cataract surgery.
Three types of intraocular lenses (IOL) are used following cataract surgery:
The allowance for the standard or conventional IOL is included in the hospital outpatient facility fee schedule and the Ambulatory Surgical Center (ASC) surgical fee schedule amount for cataract surgery.
|C1780||Lens, intraocular (New Technology)|
|V2630||Anterior chamber intraocular lens|
|V2631||Iris supported intraocular lens|
|V2632||Posterior chamber intraocular lens|
Note: C-codes are allowed on UB-04 claims only.
Blue Cross Blue Shield of North Dakota (BCBSND) will require the specific IOL HCPCS codes below to be billed on revenue code 0276 (Intraocular Lens). The charges billed for the accommodative IOL HCPCS code must be the difference between the accommodative IOL and the standard IOL charge. The amount billed on revenue code 0276 will be rejected as member liable.
|Q1004||New technology, intraocular lens, category 4 as defined in Federal Register notice|
|Q1005||New technology, intraocular lens, category 5 as defined in Federal Register notice|
|V2787||Astigmatism correcting function of intraocular lens|
|V2788||Prebyopia correcting function of intraocular lens|
|S0596||Phakic intraocular lens for correction of refractive error|
Any charges reflecting the cost of the standard lens should not be member liable and therefore should not be included in the amount billed for the accommodative IOL HCPCS. The rate for the cataract surgery includes payment for the standard IOL.
Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:
In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.
Additions: Added Limitations and Exclusions statement.
Changes: Standard and accomodative IOLs HCPCS codes listed on prior policy were included in one table. New policy language includes separate tables for standard and accomodative IOL HCPCS codes.
Deletions: Removed member coverage language as this is listed in BCBSND medical policy.
Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.