Intraocular Lens Implant - (0125)

Cigna covers standard monofocal IOL implantation for cataract extraction and specified non‑cataract indications (ocular trauma, congenital cataract/aphakia, lens subluxation/displacement, and anisometropia ≥2 D uncorrectable with glasses/contacts) and replacement when an implanted IOL becomes ineffective, while premium/presbyopia‑ or astigmatism‑correcting IOLs (including phakic IOLs) are considered convenience items and excluded/not covered in many plans. Claims require appropriate ICD‑10/HCPCS/procedure codes and clinical documentation demonstrating medical necessity (e.g., refraction and failed/intolerant contact/glasses trials for anisometropia, cataract diagnosis and preop evaluation, or operative/imaging/complication evidence for IOL failure).

"Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: following cataract extraction."