Cataract Surgery in Adults

Medically necessary cataract (lens extraction) in adults is covered when one or more documented indications exist, including symptomatic visual impairment not correctable with spectacles/contact lenses, cataract preventing monitoring/treatment of intraocular disease, lens-induced vision-threatening disease, anatomic lens abnormalities, interference with vitreoretinal surgery, or high likelihood of cataract progression from planned procedures. Elective refractive lens exchange is not covered, ancillary testing is covered only when medical necessity is documented, and simultaneous bilateral surgery is generally avoided unless separate medical necessity for each eye is documented.

"Cataract causing symptomatic visual impairment that is not correctable with a tolerable change in glasses or contact lenses and results in the patient's inability to function satisfactorily in acti..."