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CATARACT SURGERY LENS REPLACEMENT
COSTS TO MEDICARE BENEFICIARIES
Medicare has specific guidelines regarding lens replacement when done at the time of cataract surgery. Medicare will pay for standard lenses in full, but will only pay for a portion of vision-correcting lenses. Vision-correcting lenses are those that correct vision due to presbyopia or astigmatism. See below for the Medicare Beneficiary’s financial responsibility.
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CATARACT SURGERY WITH INTRA OCULAR LENS:
If you are having cataract surgery and having a standard lens implanted, Medicare pays for the lens in full.
Type of lens: Monofocal correction for near or far vision
Cost to Medicare Beneficiary: $0
PRESBYOPIA-CORRECTING LENS FOR NEAR AND FAR CORRECTION IMPLANTED DURING CATARACT SURGERY:
If you are having cataract surgery and having lenses implanted that will correct your vision (presbyopia-correcting lenses), Medicare will not pay for the presbyopia-correcting portion of the lens. In other words, Medicare will pay up to the cost of a standard lens; you are responsible for the difference in cost between a standard lens and a presbyopia-correcting lens. For each presbyopia-correcting lens, you are responsible for $745 per lens. When the lens is provided by Gwinnett Hospital System, you are required to pay $745 for each lens prior to surgery, payable to Gwinnett Hospital System.
Type of lens: PRESBYOPIA-CORRECTING (Restor, ReZoom, Crystalen)
Cost to Medicare Beneficiary: $745 per lens
Payable to: Gwinnett Hospital System prior to procedure
PRESBYOPIA-CORRECTING LENS FOR NEAR AND FAR CORRECTION IMPLANTED DURING CATARACT SURGERY:
If you are having cataract surgery and having lenses implanted that will correct your vision (presbyopia-correcting lenses), Medicare will not pay for the presbyopia-correcting portion of the lens. In other words, Medicare will pay up to the cost of a standard lens; you are responsible for the difference in cost between a standard lens and a presbyopia-correcting lens. For each presbyopia-correcting lens, you are responsible for $945 per lens. When the lens is provided by Gwinnett Hospital System, you are required to pay $945 for each lens prior to surgery, payable to Gwinnett Hospital System.
Type of lens: PRESBYOPIA-CORRECTING (Crystalen-HD)
Cost to Medicare Beneficiary: $945 per lens
Payable to: Gwinnett Hospital System prior to procedure
ASTIGMATISM-CORRECTING LENS IMPLANTED DURING CATARACT SURGERY:
If you are having cataract surgery and having lenses implanted that will correct astigmatism, Medicare will not pay for the astigmatism-correcting portion of the lens. In other words, Medicare will pay up to the cost of a standard lens; you are responsible for the difference in cost between a standard lens and an astigmatism-correcting lens. For each astigmatism-correcting lens, you are responsible for $345 per lens. When the lens is provided by Gwinnett Hospital System, you are required to pay $345 for each lens prior to surgery, payable to Gwinnett Hospital System.
Type of lens: ASTIGMATISM-CORRECTING (Toric)
Cost to Medicare Beneficiary: $345 per lens
Payable to: Gwinnett Hospital System prior to procedure
You will receive a bill from your physician for professional fees associated with your surgery. Your surgeon will bill your insurance as appropriate. You will also receive a bill from the hospital for the procedure, recovery and any supplies, tests that are performed for the procedure while you were in the hospital. The hospital will bill your insurance for these services as appropriate.
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*1-22197* FORM 1-22197 REV. 09/2010 Page 1 of 1