ModifiedCignaPolicy 0125

Intraocular Lens Implant

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This policy governs coverage and reimbursement for standard, premium, replacement, and technology-related intraocular lens implants. Coverage depends on the applicable benefit plan, policy criteria, covered diagnosis and procedure codes, and the specific clinical circumstances.

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ModifiedCignaPolicy 0125

Intraocular Lens Implant

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Sign up for Cigna Policy 0125 alerts

Get alerted when Policy 0125 changes without checking for updates manually.

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Policy Summary

PayerCigna

PolicyIntraocular Lens Implant

Policy CodePolicy 0125

Change TypeModified

Effective DateNov 1, 2026

Last ReviewNov 1, 2026

Next Review DateSep 15, 2027

Key ActionSubmit the most appropriate codes effective on the date of service and document the diagnosis and clinical circumstances supporting the applicable coverage criteria.

SourceLink

POLICY UPDATE CHANGES

The policy added statements addressing intracapsular magnifiers and intraocular lens prosthesis-mounted drug-eluting implants.

The policy revised the statement regarding intraocular lens replacement to clarify that it concerns lens dysfunction or failure.

The policy previously added a statement addressing capsular bag prostheses and updated the policy statement for standard monofocal intraocular lenses.

7Listed medically necessary indications for standard monofocal IOL implantation

3Premium IOL types excluded or not reimbursable for any indication

3IOL-related technologies considered experimental, investigational, or unproven

2Covered IOL procedure codes listed

3Covered IOL HCPCS codes listed

Coverage Criteria

Standard monofocal IOL implantation

Covered as medically necessary when ANY of the following conditions are met:

Standard monofocal IOL indications

The implant follows cataract extraction.
Trauma to the eye has damaged the lens.
The patient has congenital cataract.
The patient has congenital aphakia.
The natural lens is subluxated or displaced.
Anisometropia is 2 diopters or greater, and vision is uncorrectable with glasses or contact lenses.2 diopters or greater
Both the diopter threshold and uncorrectable-vision requirement apply.
The patient has aniseikonia.

Replacement of medically necessary IOL

Covered as medically necessary when an anatomical change, inflammatory response, infection, or lens dysfunction or failure renders the previously implanted lens ineffective or nonfunctional:

Medically necessary IOL replacement indications

An anatomical change renders the previously implanted IOL ineffective or nonfunctional.
An inflammatory response renders the previously implanted IOL ineffective or nonfunctional.
An infection renders the previously implanted IOL ineffective or nonfunctional.
Lens dysfunction or failure renders the previously implanted IOL ineffective or nonfunctional.
Examples include lens displacement, decentration, loss of fixation, or optic opacification not amenable to YAG laser capsulotomy.

Premium IOLs

Excluded in many benefit plans and/or not covered or reimbursable for ANY indication:

Premium IOL types

Presbyopia-correcting IOL.
Astigmatism-correcting IOL.
Phakic IOL.

Experimental or unproven IOL-related technologies

Not covered as experimental, investigational, or unproven for ALL indications:

IOL-related implant technologies

Capsular bag prosthesis.
Intracapsular magnifier.
Intraocular lens prosthesis-mounted drug-eluting implant.

Capsular bag prosthesis

Capsular bag prostheses are investigational because the technology is not FDA-approved and evidence is insufficient:

Investigational capsular bag prosthesis: Capsular bag prostheses, including artificial capsular bags or artificial IOL support platforms, are not approved by the U.S. Food and Drug Administration. Available evidence consists primarily of preclinical investigations, early feasibility studies, small case series, and investigational device reports and is insufficient to establish safety, effectiveness, and long-term clinical outcomes.

No formal clinical practice guidelines, consensus statements, or position statements addressing these devices were identified from major ophthalmology organizations.

Intracapsular magnifier

Intracapsular magnifiers remain investigational because FDA approval and comparative evidence are lacking:

Investigational intracapsular magnifier: Intracapsular magnifiers intended for attachment to a previously implanted IOL have not been approved by the U.S. Food and Drug Administration. Available studies suggest possible near-vision benefit in selected pseudophakic individuals with advanced age-related macular degeneration, but comparative safety and effectiveness remain uncertain because the evidence lacks randomized or comparator-controlled studies and long-term outcomes.

The AccuraSee Intraocular Pseudophakic Capsular Lens Magnifier is described as being evaluated in an FDA-approved Investigational Device Exemption clinical study.

IOL prosthesis-mounted drug-eluting implant

IOL prosthesis-mounted drug-eluting implants remain investigational because FDA approval and completed efficacy evidence are lacking:

Investigational drug-eluting IOL implant: IOL prosthesis-mounted drug-eluting implants are not approved by the U.S. Food and Drug Administration. Available evidence includes animal studies, a small single-center human study, and ongoing Phase 3 randomized controlled trials without posted results as of the cited update.

The RHINE and RHONE trials evaluate the bimatoprost implant system in adults undergoing cataract surgery with open-angle glaucoma or ocular hypertension.

Capsular bag prostheses, intracapsular magnifiers, and drug-eluting intraocular lens implants

Evidence assessment:

Evidence limitations: Published peer-reviewed evidence is insufficient to establish the safety and effectiveness of capsular bag prostheses, intracapsular magnifiers, and intraocular lens prosthesis-mounted drug-eluting implants.

Available studies are limited by small sample sizes, lack of comparator-controlled trials, and insufficient long-term outcome data.

Standard monofocal IOL implantation for any indication not listed in the policy is not covered or reimbursable. Covered indications include cataract extraction, traumatic lens damage, congenital cataract, congenital aphakia, lens subluxation or displacement, anisometropia of 2 diopters or greater with vision uncorrectable by glasses or contact lenses, and aniseikonia.

Premium IOLs are intended to reduce the need for glasses and are considered convenience items. Presbyopia-correcting IOLs, astigmatism-correcting IOLs, and phakic IOLs are excluded in many benefit plans and/or are not covered or reimbursable for any indication.

Capsular bag prostheses, intracapsular magnifiers, and IOL prosthesis-mounted drug-eluting implants are considered experimental, investigational, or unproven for all indications.

Phakic IOLs used to correct refractive error, along with the astigmatism-correcting and presbyopia-correcting functions of IOLs, are excluded in many benefit plans and/or are not covered or reimbursable.

The listed procedures involving these technologies—including capsular bag prosthesis insertion and scleral fixation, intracapsular magnifier insertion with attachment to a previously placed IOL, and attachment and insertion of an IOL prosthesis-mounted drug-eluting implant—are considered experimental, investigational, or unproven.

Coding and Product Identifiers

Standard Intraocular Lenses - CPT CodesCPTCovered

66985	Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal.
66986	Exchange of intraocular lens.

Standard Intraocular Lenses - HCPCSHCPCSCovered

C1780

Lens, intraocular (new technology).

Standard Intraocular Lenses - HCPCS CodesHCPCSCovered

V2630	Anterior chamber intraocular lens.
V2631	Iris supported intraocular lens.
V2632	Posterior chamber intraocular lens.

Standard Intraocular Lenses - ICD-10-CM Diagnosis CodesICD-10Covered

E08.36	Diabetes mellitus due to underlying condition with diabetic cataract.
E09.36	Drug or chemical induced diabetes mellitus with diabetic cataract.
E10.36	Type 1 diabetes mellitus with diabetic cataract.
E11.36	Type 2 diabetes mellitus with diabetic cataract.
E13.36	Other specified diabetes mellitus with diabetic cataract.
H25.011-	Cortical age-related cataract.
H25.031-	Anterior subcapsular polar age-related cataract.
H25.041-	Posterior subcapsular polar age-related cataract.
H25.091-	Other age-related incipient cataract.
H25.11-	Age-related nuclear cataract.

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Not Covered or Reimbursable - ICD-10-CM Diagnosis CodesICD-10Not Covered

H52.00-	Hypermetropia.
H52.10-	Myopia.
H52.201-	Unspecified astigmatism.
H52.211-	Irregular astigmatism.
H52.221-	Regular astigmatism.
H52.4	Presbyopia.
H52.511-	Internal ophthalmoplegia (complete) (total).
H52.521-	Paresis of accommodation.
H52.531-	Spasm of accommodation.
H52.6	Other disorders of refraction.

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Premium Intraocular Lenses - HCPCS CodesHCPCSNot Covered

S0596	Phakic intraocular lens for correction of refractive error.
V2787	Astigmatism correcting function of intraocular lens.
V2788	Presbyopia correcting function of intraocular lens.

Premium Intraocular Lenses - ICD-10-CM DiagnosisICD-10Not Covered

All codes

All codes.

Excluded in many benefit plans and/or not covered or reimbursable — HCPCS CodesHCPCSNot Covered

S0596	Phakic intraocular lens for correction of refractive error
V2787	Astigmatism correcting function of intraocular lens
V2788	Presbyopia correcting function of intraocular lens

Excluded in many benefit plans and/or not covered or reimbursable — ICD-10-CM DiagnosisICD-10Not Covered

All codes

All ICD-10-CM diagnosis codes

Considered Experimental/Investigational/Unproven — CPT CodesCPTExperimental

0996T	Insertion and scleral fixation of a capsular bag prosthesis containing an intraocular lens prosthesis, with vitrectomy, including removal of crystalline lens or dislocated intraocular lens prosthesis, when performed
1080T	Insertion, intracapsular magnifier, with attachment to previously placed intraocular lens
1090T	Attachment and insertion of intraocular lens prosthesis-mounted drug-eluting implant (List separately in addition to code for primary procedure)

Standard Intraocular Lens FDA Product Identifiersmixed

P930014	AcrySof Monofocal IOLs
P190018	Clareon Monofocal IOL
P990080	TECNIS Monofocal IOLs
P060011	RayOne Monofocal IOL
P910056	enVista Monofocal IOL

Premium Intraocular Lens FDA Product Identifiersmixed

P240038	FineVision HP Trifocal IOL
P030016	Visian Implantable Collamer Phakic IOLs
P030028	Artisan Phakic Intraocular Lenses
P160055	Light Adjustable Lens
P190018	Clareon Extended Vision IOLs
P930014	AcrySof Extended Vision IOLs
P980040	TECNIS Presbyopia-Correcting and Extended Vision IOLs
P040020	AcrySof Presbyopia-Correcting IOLs
P030002	Crystalens and Trulign Accommodating IOLs
P960028	Array Multifocal IOL

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FDA Product Codesmixed

HQL	FDA product code associated with listed IOL products
MFK	FDA product code associated with listed premium IOL products
MJP	FDA product code associated with listed premium IOL products
MTA	FDA product code associated with listed premium IOL products
NAA	FDA product code associated with listed premium IOL products
POE	FDA product code associated with listed premium IOL products
QCB	FDA product code associated with listed premium IOL products

Anisometropia threshold

Threshold2 diopters or greater

Vision requirementVision must be uncorrectable with glasses or contact lenses.

Policy indicationAnisometropia meeting both requirements may support medically necessary standard monofocal IOL implantation.

Provider and Billing Actions

Documentation Required

Code the service and supporting diagnosis accurately

Submit the most appropriate codes effective on the date of service and document the diagnosis and clinical circumstances supporting the applicable coverage criteria. Deleted codes or codes that are not effective when the service is rendered may not be eligible for reimbursement.

Denial Risk

Use covered codes and meet policy criteria

Claims may be denied when submitted without covered diagnosis or procedure codes, when billed for conditions not covered under the policy, or when the requested service does not meet the applicable policy criteria.

Denial Risk

Unlisted standard-IOL indication

Clinical Background

An intraocular lens (IOL) implant is a synthetic lens placed inside the eye to replace an absent, damaged, displaced, or dysfunctional natural lens and restore focusing ability and visual function. A standard monofocal IOL provides vision correction at a single focal distance and is commonly used for visual rehabilitation after cataract extraction or for specified lens abnormalities.

Definitions

Aniseikonia

DefinitionDifference in the perceived image size between the eyes.

Visual effectAn object may appear larger in one eye than in the other.

Policy relevanceAniseikonia is a listed condition for medically necessary standard monofocal IOL implantation.

Anisometropia

DefinitionDifference in the focusing power between the eyes causing each eye to focus images differently.

Clinical descriptionAnisometropia is a difference in refractive power between the eyes.

Policy threshold

Policy Summary

PayerCigna

PolicyIntraocular Lens Implant

Policy CodePolicy 0125

Change TypeModified

Effective DateNov 1, 2026

Last ReviewNov 1, 2026

Next Review DateSep 15, 2027

Key ActionSubmit the most appropriate codes effective on the date of service and document the diagnosis and clinical circumstances supporting the applicable coverage criteria.

SourceLink

On This Page

Standard monofocal IOL implantation is not covered or reimbursable for an indication other than the listed conditions. Document that the implant follows cataract extraction, addresses traumatic lens damage, congenital cataract, congenital aphakia, lens subluxation or displacement, qualifying anisometropia, or aniseikonia.

Denial Risk

Premium IOL exclusion

Premium IOL implants are intended to reduce the need for glasses and are considered a convenience item. Presbyopia-correcting, astigmatism-correcting, and phakic IOLs are excluded in many benefit plans and/or are not covered or reimbursable for any indication.

Phakic IOL for correction of refractive error: S0596
Astigmatism-correcting function of an IOL: V2787
Presbyopia-correcting function of an IOL: V2788

Denial Risk

Unproven IOL-related technologies

Capsular bag prostheses, intracapsular magnifiers, and IOL prosthesis-mounted drug-eluting implants are considered experimental, investigational, or unproven for all indications. Claims for these technologies may therefore be denied as not covered.

Billing Rule

Excluded premium or refractive lens functions

Claims involving phakic IOLs for refractive-error correction, astigmatism-correcting IOL functions, or presbyopia-correcting IOL functions may be excluded in many benefit plans and/or not covered or reimbursable.

S0596 — Phakic intraocular lens for correction of refractive error
V2787 — Astigmatism-correcting function of intraocular lens
V2788 — Presbyopia-correcting function of intraocular lens

Denial Risk

Experimental IOL-related technologies

The listed procedures involving capsular-bag prostheses, intracapsular magnifiers, or drug-eluting implants mounted on IOL prostheses are considered experimental, investigational, or unproven. Apply this guidance when reporting the associated procedures.

0996T — Insertion and scleral fixation of a capsular bag prosthesis containing an IOL prosthesis, with vitrectomy, when performed
1080T — Insertion of an intracapsular magnifier with attachment to a previously placed IOL
1090T — Attachment and insertion of an IOL prosthesis-mounted drug-eluting implant

Denial Risk

Unapproved capsular bag prosthesis

Capsular bag prostheses may be subject to noncoverage or denial because they are not FDA-approved and available evidence is insufficient to establish safety, effectiveness, and long-term clinical outcomes.

Denial Risk

Unapproved intracapsular magnifier

Intracapsular magnifiers intended for attachment to a previously implanted IOL may be subject to noncoverage or denial because they have not received FDA approval. Comparative safety and effectiveness remain uncertain because the evidence lacks randomized or comparator-controlled studies and long-term outcomes.

Denial Risk

Investigational drug-eluting IOL implant

An IOL prosthesis-mounted drug-eluting implant may be subject to noncoverage or denial because it is not FDA-approved and peer-reviewed evidence remains insufficient. Available evidence includes animal studies, a small single-center human study, and ongoing Phase 3 trials without posted results as of the cited update.

For the listed IOL indication, anisometropia must be 2 diopters or greater with vision uncorrectable by glasses or contact lenses.

Aphakia

DefinitionAbsence of the natural crystalline lens of the eye.

Clinical contextAphakia may occur when the natural lens has been removed or is absent.

Policy relevanceCongenital aphakia is a listed condition for medically necessary standard monofocal IOL implantation.

Cataract

DefinitionClouding of the eye's natural crystalline lens that may impair vision.

Clinical effectCataract is an opacity or clouding of the lens and may cause blurred or distorted vision, glare, or reduced contrast sensitivity.

Policy relevanceFollowing cataract extraction is a listed condition for medically necessary standard monofocal IOL implantation.

Lens subluxation/displacement

DefinitionPartial or complete dislocation of the natural crystalline lens from its normal position.

Related termsLens displacement may be partial, referred to as subluxation, or complete, referred to as dislocation.

Policy relevanceLens subluxation or displacement is a listed condition for medically necessary standard monofocal IOL implantation.

Monofocal IOL

DefinitionAn intraocular lens designed to provide vision correction at a single focal distance.

Focal optionsIt may be set to focus on near, intermediate, or distance vision.

Standard useMonofocal IOLs are commonly used to restore vision following removal of the natural crystalline lens.

Multifocal IOL

DefinitionA premium intraocular lens designed to provide vision correction at more than one focal distance.

Visual rangeMultifocal lenses may provide near and distance vision, and may also address intermediate vision.

Intended benefitThe technology is intended to reduce dependence on eyeglasses following lens replacement surgery.

Phakic IOL

DefinitionAn intraocular lens implanted without removal of the natural crystalline lens.

Alternative nameA phakic IOL may be referred to as an implanted contact lens.

PurposeIt alters refractive power and may reduce dependence on eyeglasses or contact lenses.

Premium IOL

DefinitionAdvanced lens technologies designed to reduce dependence on eyeglasses or contact lenses following lens replacement surgery.

ExamplesExamples include multifocal, presbyopia-correcting, astigmatism-correcting, and other specialty intraocular lenses.

Policy contextPremium IOLs are intended primarily to reduce dependence on glasses or contact lenses rather than restore basic visual function.

Refractive error

DefinitionA vision problem caused when the eye cannot focus light properly on the retina.

ExamplesExamples include myopia, hyperopia, presbyopia, and astigmatism.

Clinical effectRefractive error can cause difficulty achieving clear vision without corrective eyewear or other treatment.

Intraocular lens (IOL)

DefinitionA synthetic lens implanted within the eye after removal of the natural crystalline lens.

PurposeAn IOL restores focusing ability and improves visual function.

Clinical useMost IOL implantation is performed following lens removal for cataract, although some procedures address refractive error.

Premium intraocular lens

DefinitionAn IOL technology designed to expand the range of vision, correct astigmatism, provide refractive correction, or reduce dependence on glasses or contact lenses beyond the primary visual rehabilitation function of a standard monofocal lens.

ExamplesPremium technologies include multifocal, trifocal, extended depth-of-focus, accommodating, light-adjustable, toric, and phakic lens designs.

Policy contextPremium IOLs may be treated as convenience items because they are intended primarily to reduce dependence on glasses or contact lenses.

Monofocal intraocular lens

DefinitionAn IOL providing a single focal point.

Common useIt is commonly used after removal of the natural lens and is the standard lens option for visual rehabilitation.

Vision limitationBecause it does not restore natural accommodation, many individuals continue to require glasses for reading or other near-vision activities.

Phakic intraocular lens

DefinitionAn IOL implanted while the natural crystalline lens remains in place.

PurposeIt alters refractive power and may reduce dependence on eyeglasses or contact lenses.

PlacementPhakic IOLs may be positioned in front of or behind the iris.

Presbyopia

DefinitionAge-related loss of the eye's ability to focus on near objects as the natural crystalline lens becomes less flexible.

Common effectIndividuals may experience increasing difficulty with reading and other near-vision activities.

CorrectionPeople with presbyopia often require reading glasses or other corrective eyewear.

Intraocular lens exchange, replacement, or secondary implantation

DefinitionRemoval, replacement, repositioning, or secondary implantation of an intraocular lens.

When performedThe procedure may be required when a previously implanted IOL is displaced, loses fixation, or causes clinically significant lens-related complications.

ExamplesExamples include IOL dislocation, subluxation, decentration, optic opacification, chronic inflammation, dysphotopsia, and corneal decompensation.

Capsular bag

DefinitionA thin membrane surrounding the natural crystalline lens.

FunctionAfter cataract extraction, the capsular bag normally provides support and centration for an intraocular lens.

Clinical concernDamage or absence of the capsular bag or its supporting zonular fibers may result in aphakia, IOL instability, or IOL dislocation.

Intracapsular magnifier

DefinitionA secondary intraocular optical device implanted in a pseudophakic eye to provide magnification.

Primary useIntracapsular magnifiers are intended particularly to improve near vision in selected individuals with advanced age-related macular degeneration.

Device relationshipThe magnifier is used as an add-on or supplementary lens in conjunction with an existing IOL.

IOL prosthesis-mounted drug-eluting implant

DefinitionA medication-delivery component attached to an IOL and inserted during cataract surgery as an add-on to IOL implantation.

Investigational exampleThe SpyGlass Bimatoprost Drug Pad-IOL System consists of two nonbioerodible drug pads attached to a monofocal IOL.

Drug-release designThe pads are designed to release bimatoprost into the aqueous humor for up to 3 years.

Pseudophakic eye

DefinitionAn eye that has previously undergone implantation of an intraocular lens.

Clinical contextPseudophakia means that an IOL is present in the eye after implantation.

Related technologyIntracapsular magnifiers are designed for implantation in pseudophakic eyes as supplementary optical devices.