Reimbursement Guidelines for Punctal or Intracanalicular Occlusion by Plug

This monograph addresses reimbursement associated with punctal occlusion utilizing Oasis products including FORM FIT® (intracanalicular) plugs, Soft Plug® silicone (punctum) plugs, Soft Plug Flow Control (silicone partial-occlusion) plugs, Soft Plug Extended Duration (90-day and 180-day temporary) plugs, and Soft Plug (collagen temporary) plugs. Reimbursement by Medicare or other third party payers for this procedure involves a number…

Read More

Fundus Photography Reimbursement

This monograph describes reimbursement for fundus photography using epipole’s epiCam portable fundus camera. Fundus photography is a common ophthalmic diagnostic test useful for medical monitoring, screening, and telemedicine. Much of the information in this document is taken from official publications of the Medicare program. The reader is encouraged to check with the local Medicare Administrative…

Read More

Medicare Reimbursement for Surgical Correction of Corneal Astigmatism

The options available to manage refractive errors include spectacles, contact lenses, and a variety of surgical procedures. For the patient with an operable cataract and astigmatism, combining a cataract extraction with intraocular lens implant and correction of astigmatism can reduce or eliminate reliance on postoperative corrective lenses. This may be an attractive option for many…

Read More

Medicare Reimbursement for Baerveldt® Glaucoma Implants

This monograph is designed to address the reimbursement issues associated with implantation of the anterior chamber and pars plana Baerveldt® glaucoma implants. Medicare reimbursement for these surgical procedures and the associated devices involves several issues. These include Medicare coverage guidelines, the locations where services are rendered, the surgical procedures performed, associated tissue grafts, and the…

Read More

Medicare Reimbursement for the Hydrus® Microstent

This monograph describes reimbursement for surgery to implant the Alcon Hydrus® Microstent for primary open-angle glaucoma. Much of the information in this document is taken from official publications of the Medicare program. The reader is encouraged to check with the local Medicare Administrative Contractor (MAC) for additional information and instructions. For other third-party payers, we…

Read More

Medicare Reimbursement for Ophthalmic Diagnostic Tests

Diagnostic tests are useful to the physician in the diagnosis and management of disease. In CPT, many ophthalmic tests are found in the section entitled Special Ophthalmological Services. These CPT codes describe procedures above and beyond a general eye examination and are usually treated discretely for reimbursement purposes. In addition, some radiological tests are useful…

Read More

Billing Office Procedure Manual

The practice of medicine has undergone many changes during the past decades, not least of which is management of the practice. Numerous journal articles and books have been published on practice management and we will not attempt to recreate them here. While many are truly useful, too often they describe what results are needed and…

Read More

Medicare Reimbursement for Presbyopia-Correcting and Toric IOLs

Most intraocular lenses (IOLs) contain only spherical power and do not correct for presbyopia. Some IOLs contain sphere powers for both distance and near, and are known as presbyopia-correcting IOLs (P-C IOLs). Other IOLs also contain cylinder power for correction of astigmatism; they are known as toric IOLs or astigmatism-correcting IOLs (A-C IOLs). Some IOLs…

Read More

Medicare Reimbursement for Post-Cataract Eyeglasses

Medicare does not usually pay for eyeglasses or contact lenses. However, if the beneficiary is aphakic (H27.0-), congenitally aphakic (Q12.3), or pseudophakic following cataract surgery (Z96.1), then glasses or contact lenses are a benefit under the portion of Medicare law covering prosthetic devices. These claims are frequently longer and more involved than claims for physicians’…

Read More