Medicare AdvantageAdministrativeLow impact
MAPAP225 - Vision Hardware Billing - Added link to MAPAP108 to provide information on obtaining an organizational determination.
Blue Cross of Idaho·ID · Ophthalmology, Optometry·Reimbursement
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho Medicare Advantage policy MAPAP225 was updated to add a reference to policy MAPAP108, which provides guidance on obtaining organizational determinations for presbyopia-correcting intraocular lens (IOL) procedures. This helps clarify the process for members to understand coverage limitations for non-covered presbyopia-correction functionality.
Action Required
No immediate action required. Billing teams should be aware that when members request presbyopia-correcting IOLs, facilities and physicians are encouraged to obtain organizational determinations per policy MAPAP108 to clarify non-covered services. Continue using SC modifier for post-cataract hardware and billing optical services without SC modifier when member benefits apply.