Ophthalmic Coding Specialist Practice Test

Can patients be charged out-of-pocket for monovision IOLs?

1. Yes, always

2. No, never

3. Yes, but only with an ABN

4. CMS has no provided method

The correct answer is: CMS has no provided method

In the context of charging patients out-of-pocket for monovision intraocular lenses (IOLs), it is important to recognize the guidelines established by the Centers for Medicare & Medicaid Services (CMS). Monovision IOLs may not always be covered by Medicare, particularly if they are considered to be for presbyopia rather than a specific medical necessity. This can lead to a situation where if the patient desires this option primarily for improving their visual acuity without the lenses being deemed medically necessary, there might not be a specific billing option available through CMS for these lenses. The absence of a provided method indicates that while the procedure may be performed and the lenses used, the financial aspects surrounding them can be ambiguous without a proper coding mechanism in place for reimbursement. Thus, patients may end up paying out of pocket, but this is typically dependent on individual circumstances rather than a standardized approach fostered by CMS. This means there are no clear directives or methods outlined for charging patients for these types of lenses, making the option that states CMS has no provided method the most accurate in this case.