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Advanced Technology IOLs

Centers for Medicare and Medicaid Services (CMS) Ruling No. 05-01 allows Medicare beneficiaries the option to choose a presbyopia-correcting intraocular lens like the AcrySof® IQ ReSTOR® apodized diffractive IOL and pay for the non-covered charges relating to the implantation.

CMS Ruling 1536-R, allows Medicare beneficiaries the ability to pay for non-covered charges relating to the implantation of astigmatism-correcting intraocular lenses like the AcrySof® IQ Toric.

The guidance documents and sample forms below are provided to assist you in the coding, billing, and reimbursement process.

Guidance Documents

AcrySof® IQ ReSTOR® Sample Forms

IMPORTANT NOTE:

Form CMS-R-131 (3/11) should be used for patients with original Medicare only. Medicare Advantage plans do not permit providers to use the standard Medicare ABN or a similar waiver or release and may require a pre-authorization prior to collecting non-covered services from beneficiaries. Providers should review each individual plan and follow the appropriate process specific to that payer.

  1. Sample ABN (Advanced Beneficiary Notice) for Surgeon

  2. Sample ABN (Advanced Beneficiary Notice) for Surgeon (SPANISH)

  3. Sample ABN (Advanced Beneficiary Notice) for Facilities

  4. Sample ABN (Advanced Beneficiary Notice) for Facilities (SPANISH)

  5. Sample Notice of Exclusions From Health Plan Benefits (NEHB) for Surgeon or Facility

  6. Sample Claim Form (CMS-1500) for Surgeon

  7. Sample Claim Form (CMS-1500) for ASC

  8. Sample Claim Form (UB-04 CMS1450) for Hospital


AcrySof® IQ Toric Sample Forms

IMPORTANT NOTE:

Form CMS-R-131 (3/11) should be used for patients with original Medicare only. Medicare Advantage plans do not permit providers to use the standard Medicare ABN or a similar waiver or release and may require a pre-authorization prior to collecting non-covered services from beneficiaries. Providers should review each individual plan and follow the appropriate process specific to that payer.

  1. Sample ABN (Advanced Beneficiary Notice) for Surgeon

  2. Sample ABN (Advanced Beneficiary Notice) for Surgeon (SPANISH)

  3. Sample ABN (Advanced Beneficiary Notice) for Facilities

  4. Sample ABN (Advanced Beneficiary Notice) for Facilities (SPANISH)

  5. Sample Notice of Exclusions From Health Plan Benefits (NEHB) for Surgeon or Facility

  6. Sample Claim Form (CMS-1500) for ASC

  7. Sample Claim Form (CMS-1500) for Surgeon

  8. Sample Claim Form (UB-04 CMS1450) for Hospital


Additional Resources

An explanatory video for surgeons and staff that suggests how to talk to patients about ATIOL charges using an easy-to-understand, two-service billing concept.