Cataract surgery is the most common surgery performed on Medicare beneficiaries. Medicare covers the standard monofocal lens implant — but premium lenses (multifocal, toric) require an out-of-pocket upgrade fee. Here is what to expect.
Data source: CMS 2026 Medicare Physician Fee Schedule (MPFS) and OPPS/ASC Final Rules.
Based on CMS 2026 MPFS & OPPS Final Rules
Surgeon Fee (national average)
CPT 66984 · 20.27 RVU × $33.4009 conversion factor
~$677
ASC Facility Fee (most common)
CMS 2026 ASC Final Rule — most cataract surgery done in ASCs
~$1,126
Hospital Outpatient Facility Fee
CMS 2026 OPPS APC 5491 — higher cost than ASC
~$1,432
Premium Lens Upgrade (IOL)
Multifocal or toric lens — NOT covered by Medicare; patient pays 100%
$1,000–$4,000
Your 20% Share (standard lens, no Medigap)
After Part B deductible; ASC setting
~$360–$420
With Medigap Plan G
Only the annual Part B deductible (standard lens)
~$283
Premium lens upgrades (multifocal, toric, extended depth-of-focus) are considered elective upgrades and are not covered by Medicare regardless of medical necessity.
Medicare Part B covers cataract surgery including the standard monofocal intraocular lens (IOL) implant.
The surgery is almost always performed in an ambulatory surgery center (ASC) or hospital outpatient department — not as an inpatient.
Medicare covers one pair of eyeglasses or contact lenses after cataract surgery with IOL implant.
If you choose a premium lens (multifocal, toric), Medicare covers only the standard lens portion — you pay the difference.
No assistant surgeon is typically used for cataract surgery; the procedure takes approximately 15–30 minutes.
Costs vary significantly by location and provider
Medicare pays physicians based on Geographic Practice Cost Indices (GPCI) that differ by locality. Your actual out-of-pocket cost depends on your deductible status, supplemental insurance, and whether your providers accept Medicare assignment. Use our free calculator for a personalized estimate.
Enter your location, insurance type, and deductible status for a precise out-of-pocket breakdown — surgeon fee, facility fee, anesthesia, and post-op costs all included.
Open Free CalculatorFree · No sign-up · Based on 2026 CMS official data
Data sources: CMS 2026 Medicare Physician Fee Schedule (MPFS), 2026 Outpatient Prospective Payment System (OPPS) Final Rule, and 2026 Ambulatory Surgical Center (ASC) Payment System. Estimates are for educational purposes only and do not constitute medical or financial advice.