Policyholder Services

Does OMIC cover Femtosecond laser cataract surgery?

OMIC’s Surgery Class 3 coverage extends to all recognized techniques of cataract surgery, including ultrasonic phacoemulsification, laser phacoemulsification, intracapsular extraction and extracapsular extraction.  The Femtosecond laser is FDA-approved for use in cataract surgery to perform the anterior capsulotomy, lens fragmentation, corneal incisions, and astigmatic relaxing incisions. 

As with any new device or surgical technique, physicians should carefully conduct a risk analysis when determining whether to adopt the new approach.  Before incorporating laser cataract surgery into the practice, ophthalmologists should consider a number of factors.  While early studies laud the reproducibility and accuracy of the capsulotomy and the lower amounts of energy used during phacoemulsification, there is a lack of peer-reviewed evidence showing superiority over use of a blade. Additionally, there is a steep learning curve associated with laser cataract surgery, resulting in increased risks and higher complication rates for patients as well as longer operating times during the learning phase.  OMIC recommends that surgeons with limited experience performing laser cataract surgery should disclose their experience and level of expertise with their patients.  Another factor to consider is the high acquisition costs and other fees associated with laser cataract surgery.  These fees may not be fully covered by Medicare and surgeons are limited as to what fees they may charge.  (Please refer to the AAO ASCRS laser cataract pricing document, Guidelines for Billing Medicare Beneficiaries When Using the Femtosecond Laser, available in OMIC’s Femtosecond Laser risk management resource library, for more guidance on this issue.) Patients must be informed of any additional costs they must pay out-of-pocket for their surgery.   Furthermore, physicians must be cautious in their advertising so that the benefits of laser cataract surgery are not oversold.

A sample Femtosecond Laser consent addendum and other resources are also available in OMIC’s Femtosecond Laser risk management resource library.