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

1. Iris fixation lenses (V2631)
2. Irido-capsular fixation lenses (L8699)
3. Posterior chamber lenses (V2632)
4. Anterior chamber angle fixation lenses (V2630)

The intraocular lens listed below is not an eligible prosthetic device, as its purpose is to avoid the need for reading glasses following cataract surgery. Corrective lenses provided solely for refractive error are not a standard benefit and are excluded from coverage.

Presbyopia-correcting intraocular lens (e.g., CrystaLens, RESTOR, ReZoom - L8699, V2788)

If a member chooses to have a presbyopia-correcting intraocular lens  following cataract surgery (procedure codes 66982-66984), the lens itself will be denied as non-covered (see NOTE below). However, the surgical procedure will be eligible for payment. 

Physicians inserting a presbyopia-correcting IOL in a physician's office setting may bill code L8699 for the presbyopia-correcting IOL, along with code V2788 for the presbyopia-correcting function of the intraocular lens.  Since presbyopia-correcting IOLs are noncovered, both codes will be denied (see NOTE below).

Any additional pre- and 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 (see NOTE below).

NOTE:

Prior to surgery, the provider must obtain a signed agreement from the patient. This agreement must specifically inform the patient that he/she is responsible for the entire cost of the presbyopia-correcting intraocular lens and any additional pre- and post-operative services beyond those typically provided in conjunction with a cataract extraction with insertion of a standard IOL. This documentation must be retained in the patient’s medical record and be available upon request. If a participating, preferred, or network provider fails to get a signed agreement from the patient prior to surgery, the provider is responsible for the cost of the lens and any additional pre- and post-operative services beyond those typically provided in conjunction with a cataract extraction with insertion of a standard IOL.

When the presbyopia-correcting intraocular lens is inserted solely for the correction of refractive errors (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. A participating, preferred, or network provider can bill the member for the denied services.

Surgical fees for cataract extraction with lens insertion are to be paid under code 66982-66984, whichever is reported.

Coverage for prosthetics is determined according to individual or group customer benefits.

Description

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

A presbyopia-correcting intraocular lens is an artificial lens used to correct the visual impairment of aphakia after cataract surgery and is intended to restore a patient’s ability to see objects far away and near, in most cases without the use of contacts or eye glasses. A presbyopia-correcting intraocular lens can also be used solely to correct refractive errors.

See Medical Policy Bulletin S-14 for further information on cataract extraction.

FDA approved first accommodative IOL, Ophthalmology Times, January 1, 2004

Moving Forward with the Crystalens, Review of Ophthalmology, January 2004

The Crystalens Accommodative IOL, Supplement to Cataract & Refractive Surgery Today, March 2004

New Hope for Presbyopes, EyeNet, American Academy of Ophthalmology, May 2004