Although more than 1 million cataract surgeries are performed annually
in the United States, little is known about the frequency of use or c
ost of various services provided in connection with this procedure. To
assess the frequency with which various ophthalmic, optometric, anest
hesia, and medical services are provided in conjunction with cataract
surgery and to estimate the cost to Medicare associated with those ser
vices, we analyzed 1985 through 1988 Medicare claims records of a nati
onally representative 5% sample of Medicare beneficiaries. The experie
nce of 57 103 Medicare beneficiaries who underwent extracapsular catar
act surgery in 1986 or 1987 that was not combined with another ophthal
mologic procedure formed the basis of our analysis. Projections for cu
rrent costs were performed using 1991 charges allowed by Medicare for
physician services. We estimate that the median charge allowed by Medi
care for a ''typical'' episode of cataract surgery in 1991 was approxi
mately $2500. In addition to the $3.4 billion that Medicare spent in 1
991 on such ''typical'' episodes, Medicare spent more than $39 million
on miscellaneous ''atypical'' preoperative ophthalmologic tests, such
as specular microscopy (14% of cases) and potential acuity testing (8
% of cases), more than $7 million on postoperative ophthalmologic diag
nostic tests, such as fluorescein angiography (3% of cases), and more
than $18 million on perioperative medical services (most commonly elec
trocardiography and chest roentgenography). The major determinants of
the cost to Medicare associated with cataract surgery are the rate of
performance of cataract surgery and neodymium-YAG laser capsulotomy an
d the charges allowed for these procedures. Many other ophthalmologic
and medical services are often provided preoperatively and/or postoper
atively, but total Medicare expenditures for these services are relati
vely small.