Does Medicare cover YAG Laser Capsulotomy?

Medicare covers YAG laser capsulotomy if your doctor deems it medically necessary. Medicare pays 80% of the costs for the procedure after you pay your Part B deductible. Coverage includes exams, medication, and a year of follow-up care.

YAG laser capsulotomy procedures are typically done in a hospital outpatient department or an ambulatory surgical center. This is why Medicare Part B medical insurance rules apply to the procedure.

Your doctor must deem YAG laser capsulotomy a medically necessary procedure before Medicare will pay for it. Necessity is generally based on your report of reduced vision quality and an exam showing reduced sharpness or clarity in your vision after having cataract surgery.

Original Medicare’s vision coverage is limited. It does not pay for regular eyeglasses or contact lenses or for routine eye exams.

But it does cover traditional or laser cataract surgery. By extension, it covers YAG laser capsulotomy because it is a follow-up procedure for cataract surgery.

If you have Original Medicare, you are responsible for your Medicare Part B deductible in addition to 20 percent of the Medicare-approved cost for YAG laser capsulotomy.

Medicare estimates that the average out-of-pocket cost for Medicare beneficiaries ranges from $114 to $164, depending on whether if the procedure is performed in an ambulatory surgical center or in a hospital outpatient department.

Your actual costs can vary depending on where you live and the type of coverage you have.
A Medigap (Medicare Supplement) insurance plan can help with your out-of-pocket costs — deductibles, coinsurance and copayments — if you have Original Medicare.

Medicare Advantage plans are required to cover everything Medicare Part A and Part B cover, but they may offer additional benefits that could reduce your share of the cost. These plans are sold by private insurers and benefits can differ from plan to plan, so it’s always advisable to verify your out-of-pocket costs with your plan’s administrator.

YAG laser capsulotomy corrects complications from previous cataract surgery.

Cataracts cause the natural lens in your eye to become cloudy, reducing your visual acuity — your ability to see clearly. Cataract surgery removes the damaged natural lens and replaces it with an artificial lens.

But the proteins that caused the original cataract may continue to grow in the repaired eye — a complication called capsule clouding. It doesn’t happen with every cataract patient and usually takes about one to two years for this complication to show up in those who do develop it.

YAG laser capsulotomy removes the protein buildup from the artificial lens. The procedure takes only about a minute or two, and the laser never touches the eye. Once completed, the procedure is usually not needed again.