Cataract Surgery
L39905
Medicare covers cataract extraction (with or without intraocular lens implantation) when a clinically significant cataract causes visual impairment not correctable with glasses/contact lenses or when the lens interferes with diagnosis/management of posterior segment disease or produces vision‑threatening complications; coverage requires documented preoperative evaluation, anesthesia-risk consideration, informed consent, and postoperative outcome recording. Complex cataract procedures are covered only for specified intraoperative/anatomic indications (e.g., non-dilating pupil requiring iris expansion, zonular weakness, pediatric or mature cataracts); surgery is limited to one procedure per eye and claims should follow NCD 10.1 and CMS guidance for IOL insertion.
"Presence of cataract(s) causing visual impairment not correctable with a tolerable change in glasses or contact lenses resulting in inability to perform activities of daily living (e."