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:
- Group or Individual benefit
- Provider Participation Agreement
- Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, payment integrity edits and medical necessity
- Mandated or legislative required criteria will always supersede.
In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.
Cross Reference
NDBCBS Medical Policy – Intraocular Lens
History
Date
|
Updates
|
9/30/2019
|
Additions: Added Limitations and Exclusions statement.
Changes: Standard and accommodative IOLs HCPCS codes listed on prior policy were included in one table. New policy language includes separate tables for standard and accommodative IOL HCPCS codes.
Deletions: Removed member coverage language as this is listed in BCBSND medical policy.
|
11/18/2020
|
Added CPT code C1840
|
4/30/2021
|
Revised the policy section to clarify that the allowance for the standard or conventional IOL is included in the rate for cataract surgery.
|
7/12/2022
|
Updated format.
|
8/23/2023
|
Policy annual review completed
|
