Cataract Extraction (including Complex Cataract Surgery)

Medicare covers routine and complex cataract extraction when documented visual impairment from cataract(s) materially limits activities of daily living, is not correctable with glasses or non-surgical measures, or when the cataract causes specific complications (e.g., glare, anisometropia, secondary glaucoma, interference with posterior-segment care). Complex surgery coverage applies for intraoperative challenges such as non-dilating pupils requiring mechanical iris devices, zonular weakness, pediatric or mature cataracts requiring specialized techniques. Claims must be supported by preoperative documentation confirming the cataract as the cause, compliance with applicable NCD/CMS guidance, and performed by appropriately licensed and trained providers.

"Cataract surgery is covered when visual function no longer meets the patient's needs based on visual acuity, visual impairment, and potential for functional benefits."