Cataract Extraction

Medicare covers cataract extraction (with or without intraocular lens implant) when it is reasonable and medically necessary to treat symptomatic visual impairment not correctable with tolerable glasses or contact lenses, when cataract prevents treatment or monitoring of concomitant intraocular disease or interferes with vitreoretinal surgery, when lens-induced disease threatens ocular health, when procedures/treatments will likely accelerate cataract formation, or in specified complex and pediatric cases. Asymptomatic lens opacity without functional impairment is not covered; adequate documentation—including Snellen visual acuity, functional limitations, justification for each eye in bilateral cases, and operative details for complex surgery—is required.

"Cataract causing symptomatic visual impairment not correctable with a tolerable change in glasses or contact lenses that results in activity limitations or participation restrictions (e."