Ophthalmology and Optometry Coding Alert

Question: Can you explain when it is, and is not, appropriate to charge for the use of FS laser during cataract surgery?

Iowa Subscriber

Answer: The femtosecond (FS) laser provides a newer approach to cataract surgery. However, the availability of new technology does not mean Medicare or other insurers will pay for it. The allowable Medicare reimbursement for cataract surgery does not change according to the surgical methods used — reimbursement is the same whether a cystotome or FS laser makes the capsulotomy.

According to guidance developed by the American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery:

• Providers may not bill Medicare, a beneficiary, or their secondary insurer for additional fees to perform covered components of cataract surgery with an FS laser.
• Providers may bill the patient an additional fee for using the FS laser when performing refractive lens exchange procedures not covered by Medicare.
• Providers should not use the differential charge allowed for implantation of a premium intraocular lens to recover the costs of using the FS laser for cataract surgical steps.

Example: A 67-year-old patient seeks treatment for his cataracts. He chooses a multifocal lens and laser treatment for his astigmatism so that he will be less reliant on glasses. In this example, you are allowed to charge for the astigmatism treatment that is done by laser.