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Thread: Any input would be greatly appreciated.. new to coding lens and need help thanks

  1. #1
    Join Date
    Apr 2007

    Smile Any input would be greatly appreciated.. new to coding lens and need help thanks

    AAPC: Back to School
    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???[/SIZE]
    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)
    Last edited by KELLI; 10-25-2010 at 12:56 PM.

  2. #2
    Join Date
    Apr 2007


    This is how we bill it:

    66984 + Q1003 + V2787...for the Toric lens we charge the patient 450.00...and Medicare pays the other 50.00 = 500.00 the total amount of the Toric lens.

    of course, Medicare will not pay for the V2787...billed only for correct coding purposes...
    Last edited by elenax; 10-26-2010 at 05:42 AM.

  3. #3
    Join Date
    Apr 2007


    We also subtract the additional $50 payment for the NTIOL giving a total credit of $200 towards the price of the toric lens, as noted in your first example.

    Q1003 does end on 02/26/11, so the credit toward those lens would go back to $150


  4. #4
    Join Date
    Apr 2007


    do you also add a mark up fee for shipping??

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