Does Medicare Cover YAG Laser Capsulotomy?

Almost 20% of people who’ve had cataract surgery experience hazy or blurry vision due to the formation of scar tissue behind the lens implant. This condition, which is known as posterior capsular opacification, or PCO, is treated using a simple procedure called YAG laser capsulotomy.

Because the risk of cataracts increases as you age, Medicare beneficiaries who’ve had corrective surgery may wonder, does Medicare cover YAG laser capsulotomy for vision problems that may occur in the months or years following the procedure? The answer is yes, as long as the surgery is considered medically necessary.

Here’s what you should know about this laser surgery and its coverage under Medicare.

What Is YAG Laser Capsulotomy?

YAG laser capsulotomy is a simple laser treatment that’s used to improve the eyesight of individuals who’ve been diagnosed with posterior capsular opacification (PCO), a condition that may occur after cataract surgery.

PCO results from scar tissue on the eye’s lens membrane, also known as the capsule, which is left behind when an artificial lens replaces the eye’s natural lens during cataract surgery. The scar tissue may cause thickening and cloudiness, which can prevent light from passing through the lens and reaching the back of the eye, creating vision problems.

The physician performing the YAG laser capsulotomy uses a special laser to form a small hole in the lens so light can pass through to reach the back of the eye. The procedure, which takes approximately 5 minutes, is sometimes referred to as a posterior capsulotomy.

Does Medicare Cover YAG Laser Capsulotomy?

Medicare covers YAG laser capsulotomy if it’s medically necessary due to complications from cataracts and cataract surgery, which typically includes a diagnosis of posterior capsular opacification.

YAG laser capsulotomy may also be deemed medically necessary following a diagnosis of PCO that results from the implantation of a presbyopia-correcting intraocular lens implant (IOL).

Because the procedure is usually done on an outpatient basis, it’s covered under Medicare Part B. Coverage may include the surgery, diagnostic exams and any medications administered in a clinical setting.

YAG laser capsulotomy is also covered under Medicare Advantage (Medicare Part C) plans. Although coverage may vary by policy and carrier, Medicare Advantage plans are required to provide coverage that is at least equal to that of Original Medicare.

Beneficiaries are typically responsible for copays, coinsurance and deductibles, as outlined in the terms of their plans. 

How Much Does YAG Laser Capsulotomy Cost?

The cost for a YAG laser capsulotomy can range from several hundred dollars to about $1,500. Prices are typically affected by the individual provider and facility, your region, what type of insurance you have, and whether the procedure is being done on one or both eyes.

In 2021, Medicare beneficiaries paid $113, on average, if the procedure was performed in an ambulatory surgical center. If the procedure was performed in a hospital outpatient department, patients paid an average of $163. These averages include both facility and doctor fees.

If beneficiaries maintain supplemental insurance such as Medigap, their secondary coverage may pay for some or all of these costs.

How Do I Know If I Need YAG Surgery?

If you’ve had cataract surgery and are experiencing blurry or hazy vision due to POC, you may be a candidate for YAG surgery. Other indications that you may benefit from a YAG laser capsulotomy include:

• Double vision
• Vision loss that hinders work or leisure activities
• Experiencing excessive glare under bright lights
• Significant vision differences between eyes
• Failing a driver’s license vision exam
• Vision that’s worse after cataract surgery

You should discuss any post-cataract-surgery vision changes with your ophthalmologist, who can help you decide if YAG surgery is the right option.

Is YAG Laser Capsulotomy Effective?

In most cases, YAG laser capsulotomy is effective in restoring clear vision. Most individuals who undergo this procedure experience noticeable improvements by the morning following the surgery.

How Safe Is YAG Laser Capsulotomy?

YAG laser capsulotomy is generally considered a simple, safe outpatient procedure. However, some individuals experience mild side effects such as:

• Macular edema: This buildup of fluid in the central area of the retina may cause vision distortion. Macular edema caused by eye surgery is typically short term.
  
  
• Floaters: Floaters are gray or black specks or strings that drift across the field of vision. Floaters caused by the procedure typically disappear within a few weeks.
  
  
• Increased intraocular pressure: Increased IOP refers to elevated pressure inside the eye. It’s typically treated with eye drops or other types of medications.

These post-surgery side effects are not life-threatening and are manageable for most individuals.

What Are the Risks of YAG Laser Capsulotomy?

Although YAG laser capsulotomy is generally considered a simple, safe procedure, it occasionally results in severe complications, including:

• Glaucoma
• Corneal injury
• Macular hole
• Pupil blockage
• Retinal detachment
• Retinal hemorrhage
• Aqueous misdirection syndrome
• Inflammation of the iris
• Inflammation of the vitreous cavity

Although rare, many of these complications can lead to permanent damage to the eye and vision loss. Your ophthalmologist can help you weigh the risks of the surgery against the potential benefits.