Refractive Lenses

Medicare covers refractive lenses primarily for aphakic beneficiaries (bifocals, separate far/near lenses, or contact lens plus near-frame lenses) and replacement lenses for aphakia when medically necessary, subject to general Medicare reasonable-and-necessary requirements. Special lens features (anti-reflective, tints, oversize) require documented medical necessity by the treating practitioner, UV protection is reasonable after cataract extraction, polycarbonate lenses are limited to beneficiaries with functional vision in only one eye, and claims without required SWO/WOPD, proper coding, or proof of delivery will be denied.

"An item is covered only if it: 1) is eligible for a defined Medicare benefit category, 2) is reasonable and necessary for diagnosis/treatment or to improve functioning of a malformed body member, a..."

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