Medicare Reimbursement for Discarded Drugs

When a provider discards remaining drug in a single-use container after administering a dose, Medicare provides payment for the discarded amount, as well as the dose administered, up to the amount designated in the single-use container. This FAQ addresses the following:

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Medicare Reimbursement for Intraoperative Visual Axis Identification

During cataract surgery, the surgeon relies on anatomical markers for orientation, chiefly the pupil. In a normal eye, with monocular fixation under the operating microscope, the corneal light reflex that corresponds with the visual axis is displaced nasally about 0.5mm from the center of the pupil; this is known as positive angle kappa. Patients vary…

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Remote Physiologic Monitoring

There are four primary physiological parameters or vitals signs: body temperature, blood pressure, pulse (heart rate), and breathing rate (respiratory rate). Other human physiological parameters, including weight, blood sugar, blood oxygen saturation, and various electrophysiological signals, represent the operation of a human body and are useful as reference values in human health monitoring. This FAQ…

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Principal Care Management

CPT states, “Principal care management represents services that focus on the medical and/or psychological needs manifested by a single, complex chronic condition expected to last at least 3 months and includes establishing, implementing, revising, or monitoring a care plan specific to that single disease.” This FAQ addresses the following:

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Reimbursement Issues Related to Modifier 24

CPT defines modifier 24 as “Unrelated evaluation and management services by the same physician during a postoperative period.”  It goes on to say “The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure.” This is supported by the Medicare…

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Medicare Reimbursement for Exam Prior to Second Cataract Surgery

The evaluation before the first cataract operation does not establish the need for the second operation.  The decision for surgery must be made prior to each procedure.  The surgeon might say, “After we finish the first operation, if all goes well, we’ll consider surgery on your other eye”.  Since the patient and the surgeon hope…

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Medicare Reimbursement for Complex Cataract Surgery

A complex cataract surgery may be performed on a patient with pupils that do not dilate because of chronic parasympathomimetic drug use, scarring or trauma.  In such cases, mechanical dilation of the pupil is necessary to enable the surgeon to extract the cataract and place an IOL. This code may also apply when the surgeon…

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Medicare Reimbursement for Visual Field Testing

The National Coverage Determination for computer enhanced perimetry is NCD 80.9.  Most Medicare Administrative Contractors (MACs) also publish local coverage determination (LCD) policies that supplement the NCD. NCD 80.9 – Computer Enhanced Perimetry (Rev.1, 10-03-03) CIM 50-49 states “Computer enhanced perimetry involves the use of a micro-computer to measure visual sensitivity at preselected locations in the visual…

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Comparing Medical Exams with Routine Vision Exams

By law, Medicare does not pay for routine vision exams “…for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses for refractive errors.”  Medicare beneficiaries may choose to have routine or annual eye exams, however, the beneficiary would be responsible for payment. Some beneficiaries have vision insurance that may cover the exam. This FAQ addresses…

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Uninsured and Indigent Patients

Use your regular fee schedule for all patients.  Do not assume that uninsured necessarily means indigent. Best practices indicate that a single fee schedule is preferred over multiple fee schedules. More than one fee schedule creates patient animosity and potential legal liability under federal and state laws. A discount for self-pay is fair and reasonable when: Furthermore, prompt…

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