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Thread: Billing medicare for lens ????

  1. #1
    Join Date
    Apr 2007

    Default Billing medicare for lens ????

    AAPC: Back to School
    I need some assistance/confirmation from you both on how to properly bill for the Alcon Toric IOL. This lens in particular was deemed an NTIOL by Medicare in August 2009, which Medicare pays an additional $50 (billed as HCPCS code Q1003) to the ASC. The question is when we bill the for the incremental portion of our cost less the $150 that is included as part of 66982 or 66984, do we then subtract the $50 NTIOL or not???

    Following is an example of how an article states how to correctly charge a Medicare patient for a Toric lens:

    $500 Approximate cost of the Toric lens to the facility
    -$150 Medicare reimbursement for regular IOL as part of cataract CPT code
    - $50 Extra $50 that Medicare reimburses for the use of an NTIOL with code Q1003
    + $50 ASC’s cost for shipping and handling of lens ($50 maximum)
    – Modest mark-up
    $350 Final suggested maximum amount ASC can charge a Medicare patient

    Here is the link to the entire article:

    This is how we have been billing:

    $495 Cost of the Toric lens
    -$150 Medicare reimbursement for regular IOL as part of cataract CPT code
    +$15 ASC's cost for shipping and handling
    $360 Amount billed to physician (on behalf of patient)

  2. #2
    Join Date
    Apr 2007


    We bill the Catract code 66984 or 66982 at our standard fee with the NTIOL Q1003 at a set standard fee (which includes the $50 MCR remibursement) to ALL Insurance carriers including Medicare. Medicare reimburses us for the Cataract (which includes $150 for regular IOL) and an additional $50 for the NTIOL. So in the end MCR only be reimburses a total of $200 toward the cost of the IOL's. Works slick, most other carriers pay according to contract. FYI: You may want shop around for a cheaper supplier to keep your costs down.

  3. #3
    Join Date
    Apr 2007


    NOTE: for Non-conventional IOL's see Medicare website for model #'s for AC (Astigmatism Correcting) use HCPC V2787 or PC (Presbyopia Correcting) use HCPC V2788. We bill these IOL's at cost -$150 MCR reimbursement on cataract + markup = patient responsibility The physicians office collects the Patient responsibility difference and completes a NEMB form for us prior to surgery date. We bill Medicare for V2787 or V2788 using modifier GY in addition to CPT 66982-66984 for cataract procedure.

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