CASE FLASH: MEDICARE COVERAGE OF EYEGLASSES

Mrs. H lives in Texas, but she was spending a few months with her daughter in Minnesota. Mrs. H needed cataract surgery and decided to have the surgery done during the visit. She has Medicare Part A (inpatient coverage) and Part B (outpatient coverage). The surgery was successful, and she chose a new pair of glasses at an optometrist’s office.

A month later, Mrs. H received a letter from the optometrist she saw in Minnesota stating that Medicare had denied the claim for her glasses. Mrs. H called the Medicare Rights Center and spoke to a hotline counselor. The counselor explained to Mrs. H that while Medicare does not normally cover eye care, it should cover a new pair of glasses or contacts after cataract surgery. This pair of eyeglasses is considered Durable Medical Equipment (DME) and is covered under Part B.

The counselor explained to Mrs. H that there are a couple of companies that process Medicare Part B claims for each state. The Part B carrier deals with most outpatient services, but her state’s DME Medicare Administrative Contractor (DME MAC) would process claims for DME. The counselor suspected that the optometrist might have incorrectly sent the bill to the Part B carrier instead of to the DME MAC. The MRC counselor also told Mrs. H that because she is a resident of Texas, the bill for her glasses would need to be sent to the DME MAC in her home state, rather than to the DME MAC in Minnesota.

Mrs. H called the optometrist and asked where he had sent the bill for the eyeglasses. The optometrist said that he had submitted the bill to the Part B carrier in Minnesota. Mrs. H asked the optometrist if he could send the bill to the DME MAC in Texas. The optometrist agreed to resubmit the claim, and Medicare paid for the eyeglasses.

-From: “Case Flash: Medicare Coverage Of Eyeglasses”, Medicare Watch, Vol 10, Issue 22, October 30, 2007

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