Policy 9.01.14 considers a monofocal intraocular lens, spherical or aspheric, medically appropriate to replace the natural lens after cataract extraction. It considers multifocal, astigmatism-correcting (toric monofocal) and accommodating or trifocal IOLs not medically necessary, because no superior medical benefit has been demonstrated over the monofocal IOL other than decreasing the need for corrective eye wear. When individuals choose a toric, multifocal or accommodating lens, reimbursement is provided only for the cost of a standard or monofocal IOL. The current effective date is October 22, 2026, and the 10/22/26 annual review left the policy intent unchanged.
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01Already effective 2026-10-22: Providers: Individuals should be apprised by their eye surgeon of the option to choose a multifocal or accommodating lens prior to the cataract extraction surgery.
02Billing team: Individuals who choose a multifocal or accommodating lens must sign a beneficiary notice waiver and agree to assume liability for the additional expense.
03Billing team: Reimbursement is provided only for the cost of a standard or monofocal IOL when an individual chooses a toric, multifocal or accommodating lens.
04Billing team: Codes V2787 (astigmatism correcting function of intraocular lens) and V2788 (presbyopia correcting function of intraocular lens) are marked (NMN), not medically necessary.
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