What is the Medicare coverage for eye care and eyeglasses?

September 20, 2009 by admin

Eye Care - Following Cataract Surgery Generally, Medicare doesn't cover eyeglasses or contact lenses. However, following cataract surgery with an intraocular lens, Medicare helps pay for cataract glasses, contact lenses, or intraocular lenses provided by an ophthalmologist. Services provided by an optometrist may be covered, if the optometrist is licensed to provide this service in your state. Important:

• Only standard frames are covered.
• Lenses are covered even if you had the surgery before you had Medicare.
• Payment may be made for lenses for both eyes even though cataract surgery involved only one eye.

Medicare covers glasses or contact lenses for patients who have had cataract surgery and an intraocular lens implant. Medicare will cover these items even if the patient had surgery before Medicare benefits began. Medicare will cover one pair of glasses or contact lenses following cataract surgery. Medicare only covers standard frames. An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor. Make sure your supplier is enrolled in Medicare and has a Medicare supplier number. Suppliers have to meet strict standards to qualify for a Medicare supplier number. Medicare won't pay your claim if your supplier doesn't have a number, even if your supplier is a large chain or department store that sells more than just durable medical equipment (DME). You pay 20% of Medicare-approved amounts for one pair of eyeglasses or contact lenses after each cataract surgery with an intraocular lens. If you elect upgraded frames, Medicare will only reimburse or pay for the standard frame amount. You pay an additional cost for upgraded frames. You must purchase glasses and contacts. For more information, you may call 1-800-MEDICARE (1-800-633-4227). If a supplier of DME doesn't accept assignment, there is no limit to what you can be charged. You also may have to pay the entire bill (your share and Medicare's share) at the time you get the DME. Note: Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment. If the supplier is a participating supplier, they must accept assignment. If the supplier is enrolled in Medicare but isn't "participating," they have the option to accept assignment. If the supplier isn't enrolled in Medicare, Medicare won't pay your claim. Eye Care - Glaucoma Screening Medicare covers glaucoma screening, once every 12 months for people with Medicare at high risk for glaucoma. This includes people with diabetes, a family history of glaucoma, or African-Americans who are age 50 and older. The screening must be done or supervised by an eye doctor who is legally allowed to do this service in your state. You pay 20% of Medicare-approved amounts. Eye Care - Routine Medicare does not cover routine eye exams. Some preventive eye tests and screenings are covered by Medicare, such as Glaucoma Screening and Treatment of Macular Degeneration. You pay 100% for routine eye exams. Eye Care - Treatment of Macular Degeneration Medicare covers a treatment for some patients with age-related macular degeneration. This treatment is called ocular photodynamic therapy with verteporfin. You pay 20% of Medicare-approved amounts for diagnosis and treatment of diseases and conditions of the eye. Eye Prostheses Eye prostheses are covered for patients with absence or shrinkage of an eye due to birth defect, trauma or surgical removal. The RT and LT modifiers must be used with all HCPCS codes in this policy. Polishing and resurfacing is covered twice per year. One enlargement or reduction of the prosthesis is covered without documentation. Additional enlargements or reductions are rarely medically necessary and are covered only when information in the medical record supports the medical necessity. This information must be available to the DMERC on request. Replacement of an ocular prosthesis is governed by the five-year reasonable useful lifetime rule. Replacement of a prosthesis or prosthetic component before five years is covered if the prosthesis is irreparably damaged, lost or stolen. You pay 20% of Medicare-approved amounts. High frequency chest wall oscillation devices are in the General Prosthetics and Orthotics Devices category of DME; that means items in this policy are purchased. For more information, you may call 1-800-MEDICARE (1-800-633-4227). If a supplier of DME doesn't accept assignment, there is no limit to what you can be charged. You also may have to pay the entire bill (your share and Medicare's share) at the time you get the DME. Note: Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment. If the supplier is a participating supplier, they must accept assignment. If the supplier is enrolled in Medicare but isn't "participating," they have the option to accept assignment. If the supplier isn't enrolled in Medicare, Medicare won't pay your claim. Eye Refractions Medicare does not cover eye refractions. You pay 100% for eye refractions. Eyeglasses and Contact Lenses Generally, Medicare doesn't cover eyeglasses or contact lenses. However, following cataract surgery with an intraocular lens, Medicare helps pay for cataract glasses, contact lenses, or intraocular lenses provided by an ophthalmologist. Services provided by an optometrist may be covered, if the optometrist is licensed to provide this service in your state. Important:

• Only standard frames are covered.
• Lenses are covered even if you had the surgery before you had Medicare.
• Payment may be made for lenses for both eyes even though cataract surgery involved only one eye.

You pay 20% of Medicare-approved amounts for one pair of eyeglasses or contact lenses after each cataract surgery with an intraocular lens. You pay any additional cost for upgraded frames.