Key facts for NCD 80.12
- Benefit category
- Prosthetic Devices
- Effective date
- 05/19/1997
- Transmittal
- Transmittal 93
- Versions published
- 1
- Manual chapter
- 80
- NCD Manual (Pub. 100-03)
TL;DR
NCD 80.12 sets Medicare's national policy for intraocular lenses (iols) under the benefit category "Prosthetic Devices", effective 05/19/1997. Intraocular lens implantation services, as well as the lens itself, may be covered if reasonable and necessary for the individual. Implantation services may include hospital, surgical, and other medical services, including pre-implantation ultrasound… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
An intraocular lens, or pseudophakos, is an artificial lens which may be implanted to replace the natural lens after cataract surgery.
Indications and limitations of coverage
Intraocular lens implantation services, as well as the lens itself, may be covered if reasonable and necessary for the individual. Implantation services may include hospital, surgical, and other medical services, including pre-implantation ultrasound (A-scan) eye measurement of one or both eyes.
Text reproduced from the CMS Medicare Coverage Database record for NCD 80.12 version 1. View the original on cms.gov.
Revision history
03/1997 - Revised because FDA no longer uses the categories identified in this section to classify IOLs, and FDA no longer has adjunct studies for IOLs. Effective date 05/19/1997. (TN 93)
07/1991 - Revised to reflect that Medicare no longer covers most investigational IOLs. Effective date 05/30/1991. (TN 50)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 80.12
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 80.12
What does NCD 80.12 cover?
Intraocular lens implantation services, as well as the lens itself, may be covered if reasonable and necessary for the individual. Implantation services may include hospital, surgical, and other medical services, including pre-implantation ultrasound (A-scan) eye measurement of one or both eyes. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 80.12 take effect?
The current version (1) is effective 05/19/1997, published in transmittal 93. This is the only published version.
Does a Local Coverage Determination override NCD 80.12?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.