Department of Health
and Human Services
Centers for Medicare &
Ruling No. CMS-1536-R
Date: January 22,2007
CMS Rulings are decisions of the Administrator that serve as precedent final opinions
and orders and statements of policy and interpretation. They provide clarification and
interpretation of complex or ambiguous provisions of the law or regulations relating to
Medicare, Medicaid, utilization and peer review by Quality Improvement Organizations,
private health insurance, and related matters.
CMS Rulings are binding on all CMS components, Medicare contractors, the Provider
Reimbursement Review Board, the Medicare Geographic Classification Review Board,
and Administrative Law Judges who hear Medicare appeals. These Rulings promote
consistency in interpretation of policy and adjudication of disputes.
This Ruling sets forth CMS policy concerning the requirements for determining payment
for insertion of intraocular lenses that replace beneficiaries' natural lenses and correct
pre-existing astigmatism following cataract surgery under the following sections of the
Social Security Act (the Act):
Section 1832(a)(2)(F) for services furnished in connection with surgical
procedures performed in an Ambulatory Surgical Center (ASC).
Section 1833(t)(l)(B)(iii) for implantable items described in paragraphs (3), (6),
or (8) of section 1 861 (s) that are covered hospital outpatient department services.
a Section l86l(s)(l) for physicians' services.
Section 1861(s)(2)(A) for services and supplies furnished incident to a
physician's professional service, of kinds which are commonly furnished in.physicians'
offices and are commonly either furnished without charge or included in the physicians'
Section 1861(s)(2)(B) for hospital services incident to physicians' services
furnished to outpatients.
Section 1861 (s)(8) for one pair of conventional eyeglasses or contact lenses
furnished subsequent to each cataract surgery with insertion of an intraocular lens.