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Healthcare Common Procedure Coding System (HCPCS) Options for Acrysof® intraocular lenses used in cataract surgery

HCPCS CODE
IOL MODEL
CMS Payment Category

V2632
Posterior chamber intraocular lens

SN60AT MN60AC MA30AC MA60AC MA50BM

MN60MA MA60MA AU00T0 SA60AT SA60WF

SN60WF SN60WS SN6CWS CZ70BD

Packaged service/item; no separate payment made

V2630
Anterior chamber intraocular lens

MTA3U0 MTA4U0 MTA5U0

Packaged service/item; no separate payment made

V2787
Astigmatism-correcting function of intraocular lens (covered conventional IOL component may be reported as V2632)

SA60T5 SA6AT3 SA6AT4 SA6AT5 SA6AT6 SA6AT7

SA6AT8 SA6AT9 SN6AT3 SN6AT4 SN6AT5 SN6AT6

SN6AT7 SN6AT8 SN6AT9 SN60T5

Two-aspect reimbursement; see CMS Ruling 1536-R regarding patient responsibility for astigmatism-correcting IOLs

V2788
Presbyopia-correcting function of intraocular lens (covered conventional IOL component may be reported as V2632)

SN6AD1 SN6AD3 MN6AD1 SND1T2 SND1T3

SND1T4 SND1T5 SND1T6 SV25T0 SV25T3

SV25T4 SV25T5 SV25T6 SA25T0 SA6AD1

Two-aspect reimbursement; see CMS Ruling 05-01 regarding patient responsibility for presbyopia-correcting IOLs

Important product information

ACRYSOF® IQ RestoR® Family of Multifocal Intraocular Lenses

AcrySof® IQ ReSTOR® Family of Multifocal IOLs Important Product Information

CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician.

INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Multifocal IOLs include AcrySof® IQ ReSTOR® and AcrySof® ReSTOR® Toric and are intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. In addition, the AcrySof® IQ ReSTOR® Toric IOL is intended to correct pre-existing astigmatism. The lenses are intended to be placed in the capsular bag.

WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling for each IOL. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery.

The ReSTOR® Toric IOL should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens repositioning should occur as early as possible prior to lens encapsulation.

Some patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. A reduction in contrast sensitivity may occur in low light conditions. Visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. Spectacle independence rates vary; some patients may need glasses when reading small print or looking at small objects.

Posterior capsule opacification (PCO), when present, may develop earlier into clinically significant PCO with multifocal IOLs. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon informing them of possible risks and benefits associated with the AcrySof® IQ ReSTOR® IOLs.

Do not resterilize; do not store over 45°C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions.

ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions.

UltraSert Pre-loaded IOL Delivery System with the AcrySof® IQ aspheric IOL

ACRYSOF® IQ RESTOR® FAMILY OF MULTIFOCAL IOLS IMPORTANT PRODUCT INFORMATION

CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician.

INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Multifocal IOLs include AcrySof® IQ ReSTOR® and AcrySof® ReSTOR® Toric and are intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. In addition, the AcrySof IQ ReSTOR Toric IOL is intended to correct pre-existing astigmatism. The lenses are intended to be placed in the capsular bag.

WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling for each IOL. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery.

The ReSTOR Toric IOL should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens repositioning should occur as early as possible prior to lens encapsulation.

Some patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. A reduction in contrast sensitivity may occur in low light conditions. Visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. Spectacle independence rates vary; some patients may need glasses when reading small print or looking at small objects.

Posterior capsule opacification (PCO), when present, may develop earlier into clinically significant PCO with multifocal IOLs. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon informing them of possible risks and benefits associated with the AcrySof® IQ ReSTOR® IOLs.

Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions.

ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions.

AcrySof® IQ PanOptix® Family of Trifocal IOLs

CAUTION: Restricted by law to sale by or on the order of a physician.

DESCRIPTION: The AcrySof® IQ PanOptix® Trifocal IOL is a type of multifocal IOL used to focus images clearly onto the back of your eye (retina) to allow clear vision after the cataract removal. In addition, the center of the AcrySof® IQ PanOptix® Trifocal IOL allows for better near (reading) vision and intermediate (computer work) vision versus what a monofocal lens would provide.

There is a chance that you still may need glasses for distance, intermediate, and/or near vision. You will get the full benefit of the AcrySof® IQ PanOptix® Trifocal IOL when it is placed in both eyes. Please discuss with your eye doctor whether this is the right IOL for you.

POTENTIAL SIDE EFFECTS: Due to the design of multifocal IOLs, there are some side effects that can be associated with the AcrySof® IQ PanOptix® Trifocal IOL models. These may be worse than with a monofocal IOL, including visual disturbances such as glare, rings around lights, starbursts (rays around light sources), and reduced contrast sensitivity (decrease in ability to distinguish objects from their background, especially in dim lighting). These side effects may make it more difficult to see while driving at night or completing tasks in low lighting conditions, such as at night or in fog or in a dimly lit room, after surgery as compared to before surgery.

Further, a toric IOL corrects astigmatism only when it is placed in the correct position in the eye. There is a possibility that the toric IOL could be placed incorrectly or could move within the eye. If the toric lens is not positioned correctly following surgery, the change in your astigmatism correction by the IOL, along with any necessary correction with glasses, may cause visual distortions. If the lens rotates in your eye, you may need additional surgery to reposition or replace the IOL.

ATTENTION: As with any surgical procedure, there are risks involved. Prior to surgery, ask your eye doctor to provide you with the Patient Information Brochure for the proposed AcrySof® IQ PanOptix® Trifocal IOL to be implanted. This document will further inform you of the risks and benefits associated with this IOL. Discuss any questions about possible risks and benefits with your eye doctor, as well as your medical condition and any eye disease you may have.