National Coverage Determination (NCD)

Hydrophilic Contact Lenses

80.4

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Tracking Information

Publication Number
100-3
Manual Section Number
80.4
Manual Section Title
Hydrophilic Contact Lenses
Version Number
1
Effective Date of this Version
This is a longstanding national coverage determination. The effective date of this version has not been posted.

Description Information

Benefit Category
Prosthetic Devices


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Indications and Limitations of Coverage

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.)

Cross Reference

The Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services,” §100 and §120.
The Medicare Benefit Policy Manual, Chapter 16, “General Exclusions from Coverage,” §20 and §90.

Additional Information

Other Versions
Title Version Effective Between
Hydrophilic Contact Lenses 1 01/01/1966 - N/A You are here