LCD/NCD Portal
Automated World Health
NCD80.11
VITRECTOMY
Effective Date of this Version
6/19/2006
Benefit Category
• Ambulatory Surgical Center Facility Services
• Physicians' Services
• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
Indications and Limitations of Coverage
CIM - 35-16
• Vitrectomy may be considered reasonable and necessary for the following conditions:
o Vitreous loss incident to cataract surgery.
o Vitreous opacities due to vitreous hemorrhage or other causes.
o Retinal detachments secondary to vitreous strands.
o Proliferative retinopathy.
o Vitreous retraction.
• See chapter 23 of the Medicare Claims Processing Manual for how to determine payment for physician vitrectomy services and the Medicare Claims Processing Manual, Chapter 14, "Ambulatory Surgical Centers," §40, for how to determine payment for ASC facility vitrectomy services.
• Also, see the Medicare Claims Processing Manual, Chapter 23, "Fee Schedule Administration and Coding Requirements," §20.9, to identify when, for Medicare payment purposes, certain vitrectomy codes are included in other codes or when codes for other services include vitrectomy codes.
Coverage Transmittal Link
• http://www.cms.gov/transmittals/downloads/R48NCD.pdf
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