Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

This policy covers implantation of intraocular lenses (IOLs) for cataract removal, lens replacement after trauma or congenital lens disorders, anisometropia and presbyopic correction post‑cataract surgery, and monocular implantation of the Implantable Miniature Telescope (IMT) for select age-related macular degeneration cases. IMT coverage is limited to patients ≥65 with stable bilateral central scotoma from end‑stage AMD, visually significant cataract (grade ≥2), BCVA worse than 20/160 but not worse than 20/800, documented foveal geographic atrophy or disciform scar, successful external telescope training with ≥5‑letter ETDRS improvement and adequate fellow‑eye peripheral vision; premium/advanced‑technology IOLs (e.g., multifocal, toric, EDOF, accommodating) and refractive procedures are excluded or considered not medically necessary, and IMT is experimental if criteria are not met.

"Replacement of the natural crystalline lens when the natural lens becomes cataractous."