Post-cataract glasses benefits

February 2025

 

Post-cataract benefits are for a standard frame and standard lenses only. Beginning March 1, 2025, post-cataract claims will pay the standard frame and standard lenses only. Post-cataract glasses are meant to be an interim pair and should not include extras such as anti-reflective coating, photochromic, tints, etc. Any add-on items will be denied within the claim. Members will be responsible for out-of-pocket costs if any add-on items are billed.

 

The following diagnosis codes must be billed to satisfy the benefit requirements of post-cataract glasses:

  • H27.00 Aphakia, unspecified eye
  • H27.01 Aphakia, right eye
  • H27.02 Aphakia, left eye
  • H27.03 Aphakia, bilateral
  • Q12.3 Congenital aphakia
  • Z96.1 Presence of intraocular lens