Cost of Cataract Surgery With Medicare

Cataract Free America® makes affording cataract surgery easier for eligible seniors.

Medicare Cataract Fee Schedule

Each year through its administrative agency Centers for Medicare and Medicaid Services (CMS), Medicare determines what it considers to be the allowed value of medical care provided by doctors, hospitals, and other healthcare professionals.

Most doctors agree to not charge Medicare patients more than this allowed amount. In the vast majority of circumstances, Medicare will pay 80% of the allowed amount with the patient responsible for the remaining 20%, after the patient has met Medicare's normal $135 annual deductible for physician services. The 20% is the Medicare co-payment.

Medicare patients may pay the 20% co-payment directly to the provider, or may purchase a separate supplement insurance policy to pay the co-payments. Medicare supplemental insurance may have a deductible which must be met before payment for Medicare co-payments.

One of the benefits of Cataract Free America® is the waiver of the Medicare co-payment for eligible seniors.

Below you will find a table of the normal Medicare allowed amount and amount of the Medicare co-payment for cataract surgery related services. Not all of these services are covered under Cataract Free America® in all areas. All amounts are subject to change and regional variation. Actual services provided will determine appropriate code and charges, which may not be listed here.

New Choices, New Costs
The Decision of the IOL

An important component of modern cataract surgery is the intraocular lens (IOL) that is implanted in the eye to replace the natural lens that was affected by the cataract. Until recently Medicare would only pay for a conventional IOL. Under a new policy, Medicare will allow patients to select a high technology IOL and pay the difference between what Medicare would normally pay and the added cost of the premium IOL and related physician services. High technology IOLs are not included in this price table, however more information is at Premium IOL Cost With Medicare.

† Current Procedural Terminology Code Version IV Copyright 2010 the American Medical Association. Not all services/codes will apply. Actual amounts will vary by provider and region. Other codes and charges may be required. Additional or fewer services may be necessary. Not all services may be included or available in all areas.

†† Subject to Cataract Free America® eligibility, limitations, and exclusions.

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