Alcon Reimbursement Services (U.S. Only)
AcrySof® IQ Toric IOL (Models SN6AT3, SN6AT4, SN6AT5, collectively referred to as SN6ATT)
In May 2009, CMS included the AcrySof® IQ Toric IOL (models SN6AT3, SN6AT4, SN6AT5, collectively referred to as SN6ATT) in Ruling 1536-R.
Guidance Documents
- Elective Intraocular Lens Reimbursement Guide (pdf format, 0.55MB)
- CMS Ruling 1536-R (pdf format, 0.52MB)
- CMS's list of approved presbyopia- and astigmatism-correcting IOLs
Sample Forms
- Sample ABN (Advanced Beneficiary Notice) for Surgeon (pdf format, .04MB)
- Sample ABN (Advanced Beneficiary Notice) for Surgeon (pdf format, 27.3KB)(SPANISH)
- Sample ABN (Advanced Beneficiary Notice) for Facilities (pdf format, 0.05MB)
- Sample ABN (Advanced Beneficiary Notice) for Facilities (pdf format, 26.9KB)(SPANISH)
- Notice of Exclusions From Health Plan Benefits (NEHB) for Surgeon or Facility (pdf format, 0.09MB)
- Claim Form (CMS-1500) for ASC
- Claim Form (CMS-1500) for Surgeon (pdf format, 0.49MB)
- Claim Form (UB-04 CMS1450) for Hospital (pdf format, 0.04MB)
