Medicare:

Withdrawing Eyeglass Coverage Recommended Following Cataract Surgery

HRD-90-31: Published: Feb 8, 1990. Publicly Released: Feb 8, 1990.

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Pursuant to a congressional request, GAO examined the issues relating to Medicare reimbursement for cataract surgery.

GAO found that: (1) Medicare regulations defined routine eye care and conventional eyeglasses as refractive corrections to improve the eye's focusing ability; (2) the Health Care Financing Administration (HCFA) considered conventional eyeglasses for those Medicare beneficiaries that had cataract surgery as Medicare-reimbursable prosthetic devices; (3) aged natural lens have impaired near-vision capabilities; (4) Medicare payments for conventional eyeglasses for cataract surgery patients increased from about $60 million in 1985 to about $98 million in 1987; and (5) although GAO recommended in 1984 that HCFA discontinue payments to cataract patients for conventional eyeglasses worn over implanted prosthetic intraocular lenses or over cataract contract lenses, HCFA made no plans for a regulatory change.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: Section 4153 of the Omnibus Budget Reconciliation Act of 1990 excluded coverage of conventional eyeglasses and contact lenses subsequent to cataract surgery, with intraocular lens implant, except for the first pair.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to discontinue Medicare payment for all conventional eyeglasses or contact lenses following cataract surgery when an intraocular lens is implanted and satisfactory results are achieved.

    Agency Affected: Department of Health and Human Services

 

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