LCD/NCD Portal

NCD80.4

 

HYDROPHILIC CONTACT LENSES

 

 

Effective Date of this Version

• This is a longstanding national coverage determination.

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

 

Benefit Category

• Prosthetic Devices.

• 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 Act and are not covered when used in the treatment of nondiseased eyes with spherical ametrophia, refractive astigmatism, and/or corneal astigmatism.

o Payment may be made under the prosthetic device benefit, however, for hydrophilic contact lenses when prescribed for an aphakic patient.

• Contractors are authorized to accept an FDA letter of approval or other FDA published material as evidence of FDA approval. (See §80.1 of the NCD Manual for coverage of a hydrophilic lens as a corneal bandage.)

 

Cross Reference

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

 

 

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