Alcon Reimbursement Services (U.S. Only)
AcrySof® ReSTOR® and AcrySof® IQ ReSTOR® IOL
On May 3, 2005, CMS released Ruling No. 05-01, allowing Medicare beneficiaries the ability to pay for non-covered charges relating to the implantation of the AcrySof® ReSTOR® apodized diffractive IOL.
AcrySof® IQ ReSTOR® IOL was included in the ruling in May 2007.
Guidance Documents
- Elective Intraocular Lens Reimbursement Guide (pdf format, 0.55MB)
- CMS Ruling 05-01 (Requirements for determining coverage of presbyopia-correcting intraocular lenses) (pdf format, 0.6MB)
- CMS's list of approved presbyopia- and astigmatism-correcting IOLs
Sample Forms
- Sample ABN (Advanced Beneficiary Notice) for Surgeon (pdf format, 0.05MB)
- Sample ABN (Advanced Beneficiary Notice) for Facilities (pdf format, 0.05MB)
- Notice of Exclusions From Health Plan Benefits (NEHB) for Surgeon or Facility (pdf format, 0.06MB)
- Claim Form (CMS-1500) for ASC (pdf format, 0.09MB)
- Claim Form (CMS-1500) for Surgeon (pdf format, 0.09MB)
- Claim Form (UB-04 CMS1450) for Hospital (pdf format, 0.09MB)
