About this policy
CMS National Coverage Determination | ncd_id=233 | manual_section=80.4 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
Hydrophilic contact lenses are eyeglasses within the meaning of the exclusion in §1862(a)(7) of the Social Security Act and are not covered when used in the treatment of non-diseased eyes with spherical ametrophia, refractive astigmatism, and/or corneal astigmatism. Payment may be made under the prosthetic device benefit, however, for hydrophilic contact lenses when prescribed for an aphakic patient. Medicare Administrative Contractors are authorized to accept a Food and Drug Administration (FDA) letter of approval or other FDA-published material as evidence of FDA approval. (See §80.1 for coverage of a hydrophilic lens as a corneal bandage.)
Documentation requirements
Cross Reference: The Medicare Benefit Policy Manual , Chapter 15, âCovered Medical and Other Health Services,â §100 and §120. The Medicare Benefit Policy Manual , Chapter 16, âGeneral Exclusions from Coverage,â §20 and §90. Benefit Categories: 58 - Prosthetic Devices
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Backwork has no codes on record for this policy. Check the source.