Part of our new ChargeAssist “CDM Quick Tips” series

We often see erroneous CDM content for intraocular lenses. This brief “CDM Quick Tips” reference document outlines CMS current IOL information. CMS has a specific website for New Technology Intraocular Lenses (NTIOLs)

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/NTIOLs.html

On the above website CMS notes “There are no CMS approved NTIOLS at this time.” The CMS website has various lens information on this site as well as an xl file of past lenses designated as NTIOL historically. The key take-away is that no Q codes for NTIOLs should be listed in your chargemaster file at this time.

HCPCS Level II code Assignment for IOLs

Importantly, don’t include NTIOL coding Q1003 – Q1005 in your CDM for lenses that don’t meet this CMS designation. Note that Q1003 was deleted in 2011 and Q1004 and Q1005 are currently non-covered by Medicare.

HCPCS HCPCS
Description
OPPS SI New Deleted
Q1003 New technology intraocular lens category 3 (reduced spherical aberration)   No Yes
Q1004 New technology intraocular lens category 4 as defined in federal register notice E1 No No
Q1005 New technology intraocular lens category 5 as defined in federal register notice E1 No No

Alternative codes for intraocular lens charges are HCPCS codes in the V range. As of 1Q19, there are five V range Intraocular Lens codes as noted in the table below. Consider OPPS Status Indicators (or I/OCE edits if CAH payment methodology) to know which codes can be billed to Medicare.

HCPCS HCPCS
Description
OPPS SI New Deleted
V2630 Anterior chamber intraocular lens N No No
V2631 Iris supported intraocular lens N No No
V2632 Posterior chamber intraocular lens N No No
V2787 Astigmatism correcting function of intraocular lens E1 No No
V2788 Presbyopia correcting function of intraocular lens E1 No No

Revenue Codes

Remember that OCE edits require a HCPCS with 0276 Revenue Code for intraocular lens charges. There is no differing Revenue Code designation of “new technology” lens vs a traditional intraocular lens.

Medicare Coverage for IOLs

As noted above, look at OCE edits or OPPS Status Indicators to identify codes that CMS will allow. While there are no diagnosis restrictions for the procedure codes in the V range, one policy document was found in ChargeAssist LCD/NCD module. Transmittal 1430 of 2/1/08 outlined the use of V2787 for billing Astigmatism-Correcting Intraocular Lens (A-C IOLs) in Ambulatory Surgery Centers (ASCs), Physician Offices, and Hospital Outpatient Departments (HOPDs).

IOL Chargemaster Pricing

Ensure that IOL pricing is appropriate, as they are a commonly-charged product that patients will likely shop for. With public CDM data available, patients will be able to look up the lens price before trying to understand the entire cost of the associated insertion procedure. Because hospitals are competing with various ambulatory and physician vision center environments, be sure your pricing is competitive. (Use the ChargeAssist Pricing Studies module for this information in a variety of provider environments.)

Holliday & Associates offers ChargeAssist®; an HFMA Peer Reviewed™ Charge Master auditing and resource tool for easily auditing, collaborating, and maintaining Charge Master files. We also provide Charge Management CDM Coordinator Education and CDM Reviews by a team of credentialed clinical, coding and technical auditors.

Contact information: (800) 831-3323 | Web Site: www.ChargeAssist.com | info@chargeassist.com

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