Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
XI. Payment for Certain Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS)--Services
Excluded from Coverage
A. Low Vision Aid Exclusion
1. Background
Section 1862(a)(7) of the Act excludes payment under
Medicare Part A and Part B where “expenses are for . . .
eyeglasses (other than eyewear described in section
1861(s)(8) of the Act) or eye examinations for the purpose
of prescribing, fitting, or changing eyeglasses, procedures
performed (during the course of any eye examination) to
determine the refractive state of the eyes . . .” Section
411.15(b) excludes from coverage, eyeglasses and contact
lenses, except for--
● Post-surgical prosthetic lenses customarily used
during convalescence for eye surgery in which the lens of
the eye was removed (for example, cataract surgery);
● Prosthetic lenses for patients who lack the lens of
the eye because of congenital absence or surgical removal;
and
● One pair of conventional eyeglasses or conventional
contact lenses furnished after each cataract surgery during
which an intraocular lens is inserted.
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