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News & Press: Advocacy

No coverage for anesthesia for cataract surgery by Anthem: CSEPS joins AAO in opposition

Tuesday, March 13, 2018   (0 Comments)
Posted by: Chet Seward
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On March 12 CSEPS signed onto a letter by the American Academy of Ophthalmology opposing a new payment guidance instituted by Anthem. The new "guidance" by Anthem appears to prohibit coverage for monitored anesthesia care for cataract surgery. Anthem continues to cover local or regional anesthesia.

By signing onto the letter, CSEPS joined a growing chorus of groups that are rallying for safe eye care and against these new payer-driven recommendations that appear to be more focused on cost cutting than on quality of care. The letter calls on Anthem "to present evidence for widespread adoption and safety of unmonitored care for cataract surgery before it suggests lesser levels are acceptable."

AAO recommends that:
"Until we reach a resolution, the Academy urges ophthalmologists to refrain from charging your patients for anesthesia services. Doing so could violate contract terms; as of now, anesthesia remains a covered service." 

Any CSEPS member that has a claim denied by Anthem related to monitored anesthesia during cataract surgery is strong encourage to contact AAO with de-identified copies of any denials of claims by sending an email to