You might have heard about the new laser cataract surgery that’s been going around (when I say new, I mean within the last 3 years!). I mentioned this before in a previous cataract surgery post. Basically, it uses a process called phacofragmentation that breaks down the lens using laser technology. Well, some patients have been asking about how the billing works, since it is the most recent advancement in cataract technology and whether or not Medicare covers it.
Unfortunately, at this stage, Medicare does not cover femtosecond laser cataract surgery. Your provider can even charge you additional fee if you choose refractive lens exchange surgery that uses a femtosecond laser instead. One of the other guidelines for providers is that “Providers should not use the differential charge allowed for implantation of a premium intra-ocular lens to recover the costs of using the femtosecond laser for cataract surgical steps.”
This means that if you were to get a premium intraocular lens, then the provider would normally be able to charge you an additional fee. However with the new guidelines, they aren’t allowed to do this for the sole purpose of covering their costs for using the femtosecond laser. There are also other guidelines too, which you can find here for the American Academy of Ophthalmology site. Basically, it outlines that any kind of eye surgery that is considered necessary, like regular cataract surgery, then Medicare can cover the costs for you but if it isn’t necessary, like refractive lens exchange, then you can incur additional fees. Also, any kind of advertising by the providers have to be transparent and that any fees or pricing should be openly discussed with you. But I’m sure, you’d expect that anyway.
Just a final note, you have to keep in mind that this is relatively new and that it is subject to modification. So who knows, maybe laser cataract surgery might be covered by Medicare in the future, or even refractive lens exchange.