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CMS allows private-pay option for accommodative IOLs
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WASHINGTON — Medicare patients who desire to have a presbyopia-correcting IOL implanted during cataract surgery now have the option to pay privately for the IOL, the Centers for Medicare and Medicaid Services has ruled.
Before the new ruling, Medicare rules “prevented beneficiaries from receiving these lenses,” the CMS said in a statement. “Now beneficiaries who choose to purchase this additional feature will be able to do so.”
The CMS statement noted that payment for conventional IOLs in an outpatient setting is covered by Medicare. Providers have generally not offered presbyopia-correcting IOLs to Medicare beneficiaries “because the costs for this advanced technology substantially exceed Medicare’s payment,” the CMS said.
For example, the standard Medicare reimbursement for a conventional IOL is $200, but the suggested price for the eyeonics Crystalens is $825, the price for Alcon’s AcrySof ReStor apodized diffractive IOL will be $895 as that lens is introduced in the United States, and the ReZoom multifocal IOL from Advanced Medical Optics will be sold for $895.
The CMS ruling clarifies that a beneficiary may request insertion of a presbyopia-correcting IOL in place of a conventional IOL following cataract surgery and elect to pay privately for the difference between these amounts.
“In this case, the presbyopia-correcting IOL device and associated services for fitting one lens are considered partially covered by Medicare,” the CMS statement said. “The beneficiary is responsible for payment of that portion of the charge for the presbyopia-correcting IOL and associated services that exceed the charge for insertion of a conventional IOL.”
In a press release from eyeonics, Steven J. Dell, MD, said, "This policy change means that patients will have the right to choose a vision correction technology that best meets their lifestyle and visual demands. It also give doctors the freedom to offer innovative technologies such as the crystalens for their Medicare patients."
Eyeonics has worked with U.S. Congressman Christopher Cox, R.-Calif., and CMS for more than 5 years to change the policy, the company also noted.
The crystalens was approved for marketing in the United States in November 2003. The AcrySof ReStor and AMO ReZoom were approved in March 2005. Medicare reimbursement for these types of lenses has been the subject of debate until this ruling.