Medicare Compliance & Reimbursement

CMS expands coverage for new IOL models.

A new-technology intraocular lens compensates for corneal spherical aberrations and improves vision, earning it a new class and a $50 payment increase from the Centers for Medicare & Medicaid Services.

CMS approved Advanced Medical Optics' Tecnis® models Z9000, Z9001 and ZA9003 as part of a new "Reduced Spherical Aberration" class that will go into effect Feb. 27, 2006. The NTIOLs are eligible for an additional $50 payment adjustment when a provider dispenses them to a Medicare beneficiary in an ambulatory surgical center. The payment adjustment period expires in five years.

"For these lenses, there is clear evidence of improved functional vision and contrast acuity," says CMS Administrator Mark McClellan in a Jan. 26 statement. "Today's announcement of coverage with additional payment for an innovative type of intraocular lens reflects Medicare's attention to improved clinical benefits."

AMO's Tecnis models represent the third "New Technology" IOL class since 1999. CMS approved multifocal corrective IOLs and toric IOLs in 2000; payment adjustments for these NTIOL classes expired in May 2005.