Medicare Reimbursements for Conventional Eyeglasses

HRD-84-44: Published: Mar 7, 1984. Publicly Released: Mar 7, 1984.

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GAO reviewed the administration of Medicare reimbursements for cataract surgeries and prosthetic lenses by seven carriers in seven states.

In addition to the prosthetic lenses, which physicians prescribe to restore useful vision in patients who have aphakia because the natural lens of the eye is absent or was removed because of a cataract, conventional eyeglasses are usually prescribed for patients to provide refractive correction. Medicare has been paying for cataract eyeglasses, or any combination of prosthetic lenses determined to be medically necessary, to restore vision after the removal of the natural lens. However, Medicare does not pay for routine eye care or for conventional eyeglasses for the nonaphakic beneficiary, and has specifically excluded conventional eyeglasses from coverage. GAO estimated that the seven Medicare carriers reviewed paid about $6 million in 1982 for conventional eyeglasses worn by aphakic and pseudophakic beneficiaries. GAO found that the conventional eyeglasses worn by the aphakic or pseudophakic patient perform the same function as eyeglasses worn by the nonaphakic patient. Because coverage of conventional eyeglasses, which provide refractive correction, is specifically excluded under Medicare, covering such eyeglasses for aphakic and pseudophakic beneficiaries is inconsistent with Medicare law.

Recommendation for Executive Action

  1. Status: Closed - Not Implemented

    Comments: HCFA developed a regulation to implement this recommendation, but action was delayed by a change in administrators. On July 15, 1988, the Office of the Inspector General, in a follow-up report to the GAO report, recommended HCFA implement the recommendation. HCFA stated that it had no immediate plans to act.

    Recommendation: The Administrator of the Health Care Financing Administration (HCFA) should discontinue Medicare payments for conventional eyeglasses for aphakic and pseudophakic beneficiaries.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration


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