Hydrophilic Contact Lens For Corneal Bandage

CMS National Coverage Determination | ncd_id=136 | manual_section=80.1 | coverage_level_code=1 | national_coverage_type=True | under_review=False | lab_ncd=False

Payment may be made under §1861(s)(2) of the Social Security Act for a hydrophilic contact lens approved by the Food and Drug Administration (FDA) and used as a supply incident to a physician’s service. Payment for the lens is included in the payment for the physician’s service to which the lens is incident. Medicare Administrative Contractors are authorized to accept an FDA letter of approval or other FDA published material as evidence of FDA approval. (See §80.4 for coverage of a hydrophilic contact lens as a prosthetic device.)

Item/Service Description: Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as bullous keratopathy, dry eyes, corneal ulcers and erosion, keratitis, corneal edema, descemetocele, corneal ectasis, Mooren's ulcer, anterior corneal dystrophy, neurotrophic keratoconjunctivitis, and for other therapeutic reasons. Cross Reference: See the Medicare Benefit Policy Manual , Chapter 15, “Covered Medical and Other Health Services,” and the Medicare Benefit Policy Manual , Chapter 6, “Hospital Services Covered Under Part B,” §20.4 Revision History: 12/1994 - Explained how payment provided when hydrophilic contact lenses are furnished incident to physician's services. Effective date NA. (TN 73) Benefit Categories: 33 - Incident to a physician's professional Service; 46 - Outpatient Hospital Services Incident to a Physician's Service Transmittal: transmittal_number=73 | transmittal_issue_date=1994-12-01