Medicare and Cataract surgery - one or two charges?

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dm200
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Medicare and Cataract surgery - one or two charges?

Post by dm200 »

At some point in the future, it is near certain that I will need cataract surgery. My understanding is that this is generally (in the US) done one eye at a time. Am I correct that (under medicare rules) this would be two surgeries and two charges?

From what I read, in some other countries - it is more common that both eyes are done at once. Any knowledge if this is done in the US and, if so, is it one surgery charge?
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HueyLD
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Re: Medicare and Cataract surgery - one or two charges?

Post by HueyLD »

One eye at a time.

Two separate surgeries.
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Ged
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Re: Medicare and Cataract surgery - one or two charges?

Post by Ged »

Normally done one eye at a time. My GP was pretty insistent on this as he once had a two-eye at once patient who had gotten an infection causing loss of sight in both eyes.
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Re: Medicare and Cataract surgery - one or two charges?

Post by Doom&Gloom »

I tried to convince my doc to do both at once. He would not. He told me in the US rarely are both eyes done at once--usually only with patients with a disability that renders the procedure as no longer "routine."
alwi228
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Re: Medicare and Cataract surgery - one or two charges?

Post by alwi228 »

Two different surgeries, two different charges. It would be pretty wildly against the standard of care with how minor the surgeries are at this point to risk doing both the same day. There may also be a secondary provider that bills for the post-op care, both left and right eyes. Specifically, you will see 66984 (pending a standard surgery) or 66982 (more complicated) with 55RT or 55LT designating which eye....and the diagnosis will most likely be H25.11 for right eye and H25.12 for left. The other confusing thing you may see is that post-op care is billed as 90 units, usually three post-ops each eye. Commonly the surgeons office (if different from the post-op Dr) will bill for a portion of the post op as you are most likely in their office getting surgery done on the other eye around the time frame when you're due for the first eye post-op. I hate that I know this.
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Re: Medicare and Cataract surgery - one or two charges?

Post by adamthesmythe »

Ged wrote: Mon May 21, 2018 12:41 pm Normally done one eye at a time. My GP was pretty insistent on this as he once had a two-eye at once patient who had gotten an infection causing loss of sight in both eyes.
I would not even THINK about having both eyes done at once. Temporary complications also can happen. The US approach is what you want.
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Re: Medicare and Cataract surgery - one or two charges?

Post by likegarden »

I also had cataract surgery on both eyes, one at a time, about 3 weeks in between. There were two visits at the clinic for the surgery with two charges. When the second eye had surgery the first one had mostly healed. After 1 or 2 years you might have a short laser surgery cleaning up the first surgery results. All was paid by Medicare and my Medicare Advantage insurance for mono focal lenses, plus $125 from me at the clinic on the day of cataract surgery.
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dm200
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Re: Medicare and Cataract surgery - one or two charges?

Post by dm200 »

Thanks to all - since this is a likely "sure thing" for me - in a few years - the more educated I become - the better the financial impact may be.

With two surgeries, I suppose you would not want them to be in different years - deductibles (if applicable) and max out of pocket.
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Re: Medicare and Cataract surgery - one or two charges?

Post by jebmke »

dm200 wrote: Mon May 21, 2018 2:34 pm Thanks to all - since this is a likely "sure thing" for me - in a few years - the more educated I become - the better the financial impact may be.

With two surgeries, I suppose you would not want them to be in different years - deductibles (if applicable) and max out of pocket.
Mine were done two weeks apart. The surgeon said that they normally schedule them at least 4 weeks apart mainly because older patients have trouble with the two different drop regimes (pre/post) and it is critical that they not mix things up. The post-surgical drop routine typically is for 4 weeks I think.
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alwi228
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Re: Medicare and Cataract surgery - one or two charges?

Post by alwi228 »

Two weeks is definitely the norm, they'll do 1 week apart if your prescription is pretty significant. For example, if you're 6 units nearsighted, they'll attempt to bring the first eye back to zero and that imbalance can be pretty uncomfortable for the patient to live with for an additional week. Another thing to consider is that Medicare will help pay for glasses ONE time after surgery. It won't usually cover a full pair, but helps pay ~$200 towards a new pair (Durable Medical Equipment). Another good point to consider that was already mentioned, is that after the cataracts are removed, like clockwork you'll develop "secondary cataracts" which is Posterior Capsular Fibrosis. This mimics the interference cataracts had, but is solved with a super quick YAG laser, all covered by insurance.
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Re: Medicare and Cataract surgery - one or two charges?

Post by jebmke »

alwi228 wrote: Mon May 21, 2018 2:54 pm like clockwork you'll some develop "secondary cataracts"
When you discover that you are riding a dead horse, the best strategy is to dismount.
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Re: Medicare and Cataract surgery - one or two charges?

Post by HueyLD »

Did anyone go with premium lenses and paid an additional $2,000 - $3,000 per eye? Note that the additional cost is not covered by insurance.
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Re: Medicare and Cataract surgery - one or two charges?

Post by jebmke »

HueyLD wrote: Mon May 21, 2018 3:05 pm Did anyone go with premium lenses and paid an additional $2,000 - $3,000 per eye? Note that the additional cost is not covered by insurance.
I went with toric lenses because of acute astigmatism in both eyes. They were expensive.
When you discover that you are riding a dead horse, the best strategy is to dismount.
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Re: Medicare and Cataract surgery - one or two charges?

Post by obgraham »

As a doc, I prefer to keep things as simple as possible. So I went with the basic lenses. I used a private ophthalmologist rather than a cataract mill, and he told me well over 90% went with standard monofocal lenses, and that's what he would choose for himself.

After my supplemental plan F, I paid ZERO for my 2 surgeries. (Well, because the anesthesia guy is a friend of mine and he waived his $50 copay!)
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Re: Medicare and Cataract surgery - one or two charges?

Post by HueyLD »

obgraham wrote: Mon May 21, 2018 3:25 pm As a doc, I prefer to keep things as simple as possible. So I went with the basic lenses. I used a private ophthalmologist rather than a cataract mill, and he told me well over 90% went with standard monofocal lenses, and that's what he would choose for himself.
I have been looking for those who chose premium lenses and are happy with the result, I.e. money well spent from their personal experience.
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dm200
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Re: Medicare and Cataract surgery - one or two charges?

Post by dm200 »

obgraham wrote: Mon May 21, 2018 3:25 pm As a doc, I prefer to keep things as simple as possible. So I went with the basic lenses. I used a private ophthalmologist rather than a cataract mill, and he told me well over 90% went with standard monofocal lenses, and that's what he would choose for himself.
After my supplemental plan F, I paid ZERO for my 2 surgeries. (Well, because the anesthesia guy is a friend of mine and he waived his $50 copay!)
So, apparently, there are Ophthalmologists that just do a large volume of such surgeries?
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Re: Medicare and Cataract surgery - one or two charges?

Post by adamthesmythe »

obgraham wrote: Mon May 21, 2018 3:25 pm As a doc, I prefer to keep things as simple as possible. So I went with the basic lenses. I used a private ophthalmologist rather than a cataract mill, and he told me well over 90% went with standard monofocal lenses, and that's what he would choose for himself.

After my supplemental plan F, I paid ZERO for my 2 surgeries. (Well, because the anesthesia guy is a friend of mine and he waived his $50 copay!)
I am not a doc (at least not the medical kind) and I intend to go for simple also. I've been wearing glasses forever so I have no need to stop.

I need to do this sometime...maybe sometime soon...and need to pick a doctor. So what's the story about private vs. cataract mill? How do you tell the difference and why? Isn't it usually better to pick someone who does an operation frequently?
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Re: Medicare and Cataract surgery - one or two charges?

Post by obgraham »

Here's my opinion on doc choice. It is just my opinion. Feel free to disagree. I do not live in a community with any teaching or university hospitals/clinics.

Around here there are two different approaches to the cataract surgery. There are clinics that just do cataracts. An MD Ophthalmologist does the surgery. The preop and the postop care is done by a number of local optometrists (OD's). The operating surgeon may travel between a number of clinics from day to day. A typical day at the clinic in my town (I'm referring to it as the "mill", perhaps a bit undeservedly) does 30 cataracts in a day's work. Obviously, the docs are very skilled in what they do, and the process is made as efficient as possible.

My personal ophthalmologist, who I've known for years, is in a "private" partnership of 2. The MD's there make the decision about the surgery, no outside OD's. His partner does all the cataracts, and they have their own operating suite. He operates one day a week, averages 10 cases that day. Though they use technicians a lot like everyone else, the ophthalmologist does all his own preop and postop evaluation personally.

I've known folks who went both ways, and though I'm sure there are occasional poor outcomes I think that is very rare these days in cataract surgery, regardless of where it is done. I'm just relating here what my personal choices were.
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Re: Medicare and Cataract surgery - one or two charges?

Post by dm200 »

obgraham wrote: Mon May 21, 2018 3:45 pm Here's my opinion on doc choice. It is just my opinion. Feel free to disagree. I do not live in a community with any teaching or university hospitals/clinics.
Around here there are two different approaches to the cataract surgery. There are clinics that just do cataracts. An MD Ophthalmologist does the surgery. The preop and the postop care is done by a number of local optometrists (OD's). The operating surgeon may travel between a number of clinics from day to day. A typical day at the clinic in my town (I'm referring to it as the "mill", perhaps a bit undeservedly) does 30 cataracts in a day's work. Obviously, the docs are very skilled in what they do, and the process is made as efficient as possible.
My personal ophthalmologist, who I've known for years, is in a "private" partnership of 2. The MD's there make the decision about the surgery, no outside OD's. His partner does all the cataracts, and they have their own operating suite. He operates one day a week, averages 10 cases that day. Though they use technicians a lot like everyone else, the ophthalmologist does all his own preop and postop evaluation personally.
I've known folks who went both ways, and though I'm sure there are occasional poor outcomes I think that is very rare these days in cataract surgery, regardless of where it is done. I'm just relating here what my personal choices were.
Learning a lot .. Seems to me that I would prefer a surgeon who does a complete evaluation of my eye health and issues - not just the cataracts. Yes - I would also want the Ophahalmologist to do a lot of such surgery as well.
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Re: Medicare and Cataract surgery - one or two charges?

Post by Doom&Gloom »

jebmke wrote: Mon May 21, 2018 3:07 pm
HueyLD wrote: Mon May 21, 2018 3:05 pm Did anyone go with premium lenses and paid an additional $2,000 - $3,000 per eye? Note that the additional cost is not covered by insurance.
I went with toric lenses because of acute astigmatism in both eyes. They were expensive.
So did I. $900/eye. Best $1800 I ever spent in my life.
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Re: Medicare and Cataract surgery - one or two charges?

Post by Good Listener »

If you have them together or separate, what difference does it make once you've paid the deductible? And even if somehow there is a difference, would you really risk both eyes at the same time?
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Re: Medicare and Cataract surgery - one or two charges?

Post by Good Listener »

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Re: Medicare and Cataract surgery - one or two charges?

Post by Good Listener »

obgraham wrote: Mon May 21, 2018 3:25 pm As a doc, I prefer to keep things as simple as possible. So I went with the basic lenses. I used a private ophthalmologist rather than a cataract mill, and he told me well over 90% went with standard monofocal lenses, and that's what he would choose for himself.

After my supplemental plan F, I paid ZERO for my 2 surgeries. (Well, because the anesthesia guy is a friend of mine and he waived his $50 copay!)
I don't understand. If you have Plan F as I do, as long as the doctor takes Medicare, there is no out of pocket. Where does your copay come from?
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Re: Medicare and Cataract surgery - one or two charges?

Post by HueyLD »

Doom&Gloom wrote: Mon May 21, 2018 7:57 pm
jebmke wrote: Mon May 21, 2018 3:07 pm
HueyLD wrote: Mon May 21, 2018 3:05 pm Did anyone go with premium lenses and paid an additional $2,000 - $3,000 per eye? Note that the additional cost is not covered by insurance.
I went with toric lenses because of acute astigmatism in both eyes. They were expensive.
So did I. $900/eye. Best $1800 I ever spent in my life.
$900 per lens? Are you in the United States?

I was quoted about $1,800 per toric lens and I don't live in a HCOL area.
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Re: Medicare and Cataract surgery - one or two charges?

Post by Androo »

We will all need cataract surgery if we live long enough. It’s the most commonly performed surgery and newer technologies have dramatically improved safety and outcomes. That said, it’s surgery and there are inherent risks.

Don’t consider doing both eyes less than two weeks apart. A month is better.

Toric IOLs are a reasonable consideration if you have significant astigmatism.

Multifocal IOLs aren’t for everyone - don’t go that route if you have any type of macular disease. Personally, I’ll do standard single-focus IOLs because the best corrected visual acuity is sharper.
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Re: Medicare and Cataract surgery - one or two charges?

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dm200 wrote: Mon May 21, 2018 12:37 pm At some point in the future, it is near certain that I will need cataract surgery. My understanding is that this is generally (in the US) done one eye at a time. Am I correct that (under medicare rules) this would be two surgeries and two charges?

From what I read, in some other countries - it is more common that both eyes are done at once. Any knowledge if this is done in the US and, if so, is it one surgery charge?
Before I retired a bunch of years ago, we were sometimes adding the first or second patient of the day back to the end of the list to do the second eye, same day. Generally, these were patients who had traveled great distance for the surgery.
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Re: Medicare and Cataract surgery - one or two charges?

Post by Doom&Gloom »

HueyLD wrote: Mon May 21, 2018 9:09 pm
Doom&Gloom wrote: Mon May 21, 2018 7:57 pm
jebmke wrote: Mon May 21, 2018 3:07 pm
HueyLD wrote: Mon May 21, 2018 3:05 pm Did anyone go with premium lenses and paid an additional $2,000 - $3,000 per eye? Note that the additional cost is not covered by insurance.
I went with toric lenses because of acute astigmatism in both eyes. They were expensive.
So did I. $900/eye. Best $1800 I ever spent in my life.
$900 per lens? Are you in the United States?

I was quoted about $1,800 per toric lens and I don't live in a HCOL area.
Yes. LCOL area. Two years ago. Medicare + Plan F. $900/eye OOP. Private practice ophthalmology group--not a cataract mill.
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Re: Medicare and Cataract surgery - one or two charges?

Post by Gatorbh »

Kaiser published a large series of bilateral simultaneous cataract surgeries with good outcomes out of their Denver system. Very provocative study for the ophthalmology community. Most centers are doing one eye at a time for the concern of a rare but devastating outcome related to a complication such as infection.

My personal opinion is that multi focal lenses aren’t worth the hassle or money for most folks. Toric lenses however are a totally different matter. I would go that route if my measurements deemed it potentially helpful. Many folks use phrases such as “I have never seen that well, ever” after getting a toric lens. Some manufacturers lenses are known to hold position and rotate less than others. A rotated toric lens will require another procedure to reposition. Something to inquire about. Expect to pay extra for a toric lens. This can vary widely and can depend on whether a touch up procedure may be included.

For any medical procedure, cataract surgery included, outcomes are usually better with surgeons who do plenty.
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Re: Medicare and Cataract surgery - one or two charges?

Post by obgraham »

Good Listener wrote: Mon May 21, 2018 8:07 pm
obgraham wrote: Mon May 21, 2018 3:25 pm As a doc, I prefer to keep things as simple as possible. So I went with the basic lenses. I used a private ophthalmologist rather than a cataract mill, and he told me well over 90% went with standard monofocal lenses, and that's what he would choose for himself.

After my supplemental plan F, I paid ZERO for my 2 surgeries. (Well, because the anesthesia guy is a friend of mine and he waived his $50 copay!)
I don't understand. If you have Plan F as I do, as long as the doctor takes Medicare, there is no out of pocket. Where does your copay come from?
Non participating anesthesiologist. Which, of course, you seldom get to choose.
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Re: Medicare and Cataract surgery - one or two charges?

Post by scifilover »

DW just had both eyes done with Toric IOL implanted. Cost of the Torics was $586 each in Seattle area. This was not covered by Medicare, however she won't need glasses now. Two week separation between procedures. Could see well the day after in each eye.
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Re: Medicare and Cataract surgery - one or two charges?

Post by tev9876 »

I'm far from Medicare and normal cataract age, but did have one appear in only one eye in my mid 40s. I opted for the multifocal IOL since I hope to have it another 40+ years. My vision in the surgical eye is 20/20 and also fine for reading. My other eye seems to have actually gotten better since I stopped wearing contacts. Only side effect is I get a halo around lights at night but that disappears within a few minutes once my eye adjusts. I have a pair of distance only glasses I mainly use for night driving and am fine without any correction for day driving, TV watching, golf, reading, computers, ...... Worth the $3000 premium IMO. Two years later there is still no indication of a cataract in the other eye.
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Re: Medicare and Cataract surgery - one or two charges?

Post by CULater »

I went to a major University clinic and the doc there strongly recommended toric implants and also recommended mono vision, in which the dominant eye is corrected to distance and the other eye is corrected for near vision. With regard to toric, he said that's pretty much a "no-brainer" these days. He does cataract surgery at the VA for vets and these are covered, so he just does toric implants without even discussing it as an option. The only reason not to do them, he said, is if you can't cough up the out-of-pocket. The toric implants cost me about $900 each out-of-pocket. These have worked fine for me, allowing me to go without glasses. There's a little bit of residual astigmatism that I got prescription glasses to correct. As far as the mono vision procedure is concerned, I find that I can go without glasses for both far and near vision. I debated a long time about doing that, but finally decided that if it didn't work out, I'd end up wearing glasses all the time. Many of my friends who have just had the standard procedure wear glasses all the time too, because they get tired of taking glasses on and off to do things like using a smartphone, computer, car dash electronics, etc. So, I figured the downside would be the same and maybe I'd have some upside which is how it's turned out. I rarely need glasses at all, except in situations where I want the best possible binocular distance vision; i.e., golf and driving at night.
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