Cataract Extraction (including Complex Cataract Surgery)

Medicare covers cataract extraction, including complex cataract surgery, when cataract-related visual impairment impairs activities of daily living, is not correctable by non-surgical measures, and documentation confirms the cataract as the cause and medical necessity. Complex procedures (miotic pupil requiring iris expanders, zonular weakness needing capsular tension devices, pediatric or mature cataracts requiring special techniques) are covered when documented; surgery is not covered when tolerable refractive correction suffices, the patient's function/ADLs are not compromised, the patient cannot safely undergo surgery, or no benefit is expected. Coverage requires preoperative documentation, adherence to CMS NCDs and manuals, provider licensure/scope compliance, and is subject to post-payment review and audits.

"Visual function no longer meets the patient's needs based on measured visual acuity, visual impairment, and potential for functional benefit."