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Ophthalmology Resource Information

The Medicare Learning Network

The Medicare Learning Network® (MLN) Products Ophthalmology Resource Information page provides information for health care professionals who provide ophthalmic services to beneficiaries.

CMS Rulings and Assisted Guidance

  • Laser-Assisted Cataract Surgery and CMS Rulings 05-01 and 1536-R – Requirements for Medicare Coverage and payment for cataract surgery is the same irrespective of whether the surgery is performed using conventional surgical techniques or bladeless computer controlled laser (see "Related Links" section below)
  • CMS Ruling CMS-1536-R - Requirements for Determining Coverage of Astigmatism-Correcting Intraocular Lenses that Provide Two Distinct Services for the Patient: (1) Restoration of Distance Vision Following Cataract Surgery, and (2) Refractive Correction of Vision Due to Preexisting Astigmatism, with Less Dependency on Surgical Correction, Eyeglasses, or Contact Lenses (see "Downloads" section below)
  • CMS Ruling 05-01 - Requirements for Determining Coverage of Presbyopia-Correcting Intraocular Lenses that Provide Two Distinct Services for the Patient: (1) Restoration of Distance Vision Following Cataract Surgery, and (2) Refractive Correction of Near and Intermediate Vision with Less Dependency on Eyeglasses or Contact Lenses (see "Downloads" section below)

Change Request

  • Change Request 5853, Transmittal 1430 - Use of HCPCS V2787 When Billing Approved Astigmatism-Correcting Intraocular Lens (A-CIOLs) in Ambulatory Surgery Centers (ASCs), Physician Offices, and Hospital Outpatient Departments (HOPDs) (see "Downloads" section below)

Internet-Only Manuals (IOM)

Program instructions are day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. They are used by CMS program components, contractors, and State survey agencies to administer CMS programs. For many others, they are a good source of technical and professional information about the Medicare and Medicaid programs. (see "Downloads" section and click on IOMs to access specific chapters related to ophthalmology)

Educational Products

See "Downloads" section

  • Medicare Vision Services – This fact sheet is designed to provide education on Medicare coverage and billing information for vision services.
  • Vision Rehabilitation for Elderly Individuals with Low Vision or Blindness – A Technology Assessment Program from the Agency for Healthcare Research and Quality.
  • Quick Reference Guide: Medicare Covered Preventive Services – This guide includes, among other things, information about Medicare coverage of glaucoma screening.

Press Center– Medicare News

See the "Downloads" section

Special Society Links

See "Downloads" section

Physician Fee Schedule 

See "Related Links" section

  • Physician Fee Schedule - Information at this site includes relative value units, payment of procedure codes paid under the fee schedule, public use tables, HCPCS level data, and utilization data.
  • Physician Fee Schedule Overview - Files at this site include relative value units (RVUs), database indicator, description of database indicators, anesthesia files, imaging codes subject to the outpatient prospective payment system (OPPS) cap, geographic practice cost index (GCPIs) list and locality list.

National Correct Coding Initiative (NCCI) Edits

The CMS developed the NCCI to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. See the "Related Links" section, click on NCCI edits, in the left hand column scroll to "NCCI Coding Edits".

Ambulatory Surgical Center (ASC) Payment Overview 

See Related Links section

  • ASC Payment - Approved HCPCS Codes and Payment Rates
  • ASC Certification & Compliance - Basic information about being certified as a Medicare and/or Medicaid ASC provider and includes links to applicable laws, regulations, and compliance information.

New Technology Intraocular Lenses (NTIOLs)

ASC, CMS approved NTIOL information (see "Related Links" section)

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