Coverage for post cataract enhancement services is indicated by the following comment: “Patient is eligible for exam and materials after cataract surgery. Call Customer Service.”

Please call VSP at 800.615.1883 for an authorization. Verify copay and coverage details on the Patient Record Report.

Our post-cataract services are based on national Medicare guidelines. Patients can get post-surgical exams and materials covered up to the plan allowance, minus any copays. Please call VSP for an authorization for post-cataract exams and materials. Pre-certification isn’t required.

This isn’t a medical benefit and doesn’t cover postoperative/ambulatory care. The benefit only covers a comprehensive or intermediate exam and corrective materials needed after cataract removal or the lack of an intraocular lens (IOL).

Eligibility

Aphakic with IOL (pseudophakia): Post-surgical exam and one pair of eyeglasses or contact lenses after each cataract surgery with IOL insertion (diagnosis code Z96.1) once per lifetime per operative eye.

Aphakic without IOL: In addition to the post-surgical exam, aphakic patients who do not have an IOL (aphakia diagnosis codes H27.00 - H27.03 or Q12.3) are covered for the following lenses or combination of lenses after each cataract surgery when visually necessary:

• Bifocal lenses in frames; or
• Lenses in frames for distance vision and lenses in frames for near vision (two pairs of glasses); or
• Conventional contact lenses for distance vision, eyeglasses for near vision to wear with contact lenses, and eyeglasses to wear when the contact lenses have been removed.

Lens Materials

The following lens enhancements may be covered following cataract extraction when visually necessary and documented by the treating doctor:

• Tints (V2744-V2745)
• Anti-reflective coating (V2750)
• UV lenses (V2755)
• Oversize lenses (V2780)
• Follow the instructions on the Patient Record Report for covered and non-covered lens enhancements

Frames

Only standard frames are covered (V2020). Deluxe frames (V2025) aren’t covered, but your patient may pay to upgrade frames. Tell patients about price differences in advance. They must sign an “Advanced Beneficiary Notice” agreeing to pay the extra charge.

Non-Covered Materials

If your patient chooses materials other than those covered, the cost of those materials is a private transaction between you and your patient. We don’t cover replacement frames, eyeglasses, or contact lenses. Presbyopia-correcting intraocular lenses (IOLs) are also not covered.