Medicare_Carriers_Manual / 5256 / 5256

Why This Topic Matters

The section helps readers understand how Medicare applies payment limits and charge restrictions to selected ophthalmic services in different settings. It is useful for evaluating whether a claim may be subject to special pricing or reimbursement constraints.

Article Sections

1. 5256 LIMITS ON PAYMENTS AND CHARGES FOR OTHER SERVICES AND ITEMS

   Introduces the scope of this manual section and the broad subject of Medicare payment and charge limitations for selected services and items.

2. A. A-Mode Ophthalmic Ultrasound Procedures

   Discusses payment and charge limits related to ophthalmic ultrasound services, including how the rules differ by service setting and physician participation status.

3. B. Intraocular Lenses (IOLs)

   Addresses Medicare payment limitations for intraocular lenses in physician office and ambulatory surgical center settings, along with related charge considerations.