Alcon Reimbursement Services (U.S. Only)
AcrySof® ReSTOR® and AcrySof® ReSTOR® Aspheric
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 ReSTOR® apodized diffractive IOL. In a subsequent transmittal, CMS announced that if facilities wish to list the noncovered charges associated with the implantation of presbyopia-correcting IOL on the CMS claim form, they should use a newly created HCPCS code, V2788 (Presbyopia correcting function of an IOL), for those charges. Please refer to the documents below for additional information regarding AcrySof® ReSTOR®. AcrySof® ReSTOR® Aspheric was included in the ruling in May 2007.
Guidance Documents
- Quick Reference Guide for Coding and Billing (pdf format, 149KB)
- Non-clinical Frequently Asked Questions (pdf format, 610KB)
- CMS Ruling 05-01 (Requirements for determining coverage of presbyopia-correcting intraocular lenses) (pdf format, 54KB)
Sample Forms
- Sample ABN (Advanced Beneficiary Notice) for Surgeon (pdf format, 49KB)
- Sample ABN (Advanced Beneficiary Notice) for Facilities (pdf format, 49KB)
- Notice Of Exclusions From Health Plan Benefits (NEHB) for Surgeon or Facility (pdf format, 64KB)
- Claim Form (CMS-1500) for ASC (pdf format, 90KB)
- Claim Form (CMS-1500) for Surgeon (pdf format, 92KB)
- Claim Form (UB-04 CMS1450) for Hospital (pdf format, 92KB)