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Date:  October 5, 1995
For Release:  Immediately
Contact:  HCFA Press Office, (202) 690-6145

Medicare Policy Proposed for Eye Surgery

The U.S. Department of Health and Human Services today proposed a national policy on Medicare coverage of cataract surgery, the most commonly performed surgical procedure covered by the Medicare program.

The proposed rules, when published in final form, "will help to protect Medicare beneficiaries from unnecessary surgery and help assure that Medicare dollars are spent effectively," said HHS Secretary Donna E. Shalala.

Analyses by HHS and the General Accounting Office, a research arm of Congress, have found that a number of cataract surgeries are unnecessary. The Medicare program is authorized by law to pay only for medically necessary services.

For cataract removals and related procedures in 1994, Medicare payment amounted to over $1.4 billion for approximately 2 million procedures. The average payment was about $700.

"The proposed rules specify that the mere presence of a cataract does not mean that surgery is needed," said Bruce C. Vladeck, administrator of the Health Care Financing Administration. "Surgery will not be considered necessary if the individual is able to function normally or if the condition can be corrected with eyeglasses."

This position is consistent with the clinical practice guideline, "Cataract in Adults, Management of Functional Impairment," developed by a panel of private sector experts with support from HHS' Agency for Health Care Policy and Research. The expert panel's findings, based on a comprehensive evaluation of the scientific evidence and outcomes associated with cataracts, were issued Feb. 25, 1993.

The notice also requires functional impairment in order for Medicare to cover a procedure known as Nd:YAG capsulotomy, which corrects a condition that often develops after the original cataract surgery. Other provisions in the notice reaffirm that pre-surgery tests will continue to be paid for by Medicare on the basis of a comprehensive fee.

"The new Medicare proposal on cataract surgery is consistent with sound medical practice and reinforces our commitment to quality care for beneficiaries," Vladeck said.

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