Cataract Surgery Refraction Costs

Question: My wife just had Cataract Surgery. The cataract Surgeon billed her $50 for the refraction he carried out before the operation saying that it is an extra service not covered by Medicare. She also elected to have special lens implants for $1200 per eye which we paid. Our feeling is that the refraction is part of the entire examination and procedure and should not be an extra. Please help me with this question.


Answer: Whether your wife had Cataract Surgery or not, the Medicare regulations indicate that refraction is a non covered service. So, even your doctor billed Medicare they would get a denial of coverage notice and bill you for the service. The refraction is relevant to the calculation of the intraocular lens implant (IOL) power and prescription but is simply not a covered service. This not a new regulation.

Unfortunately whether patients like it or not, this is how Medicare elects to treat refraction. This is the same as with the special lens implants-Medicare does not pay for them. They pay for basic lens implants only and tell the Cataract Surgeons to bill the patient for anything else. Medicare does pay for the surgery center facility fee which includes a basic monofocal lens implant and the Cataract Surgeon's surgical fee.

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