LCD/NCD Portal

NCD80.1

 

HYDROPHILIC CONTACT LENS FOR CORNEAL BANDAGE

 

Effective Date of this Version

• This is a longstanding national coverage determination.

• The effective date of this version has not been posted.

 

Benefit Category

• Incident to a physician's professional Service.

• Outpatient Hospital Services Incident to a Physician's Service.

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

 

Item/Service Description

• Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as:

o Bullous keratopathy.

o Dry eyes.

o Corneal ulcers and erosion, keratitis.

o Corneal edema.

o Descemetocele.

o Corneal ectasis.

o Mooren's ulcer.

o Anterior corneal dystrophy.

o Neurotrophic keratoconjunctivitis.

o Other therapeutic reasons.

 

Indications and Limitations of Coverage

• Payment may be made under §1861(s)(2) of the Act for a hydrophilic contact lens approved by the Food and Drug Administration (FDA) and used as a supply incident to a physician's service.

• Payment for the lens is included in the payment for the physician's service to which the lens is incident.

• Contractors are authorized to accept an FDA letter of approval or other FDA published material as evidence of FDA approval.

• (See §80.4 of the NCD Manual for coverage of a hydrophilic contact lens as a prosthetic device.)

 

Cross Reference

See the Medicare Benefit Policy Manual, Chapter 15, §§100 and 120 and Chapter 16, §§20 and 90.

 

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