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…

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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…

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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…

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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…

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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…

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Medicare Reimbursement For MicroPulse® Transscleral Cyclophotocoagulation

This monograph addresses the reimbursement issues associated with MicroPulse® transscleral cyclophotocoagulation (TSCPC). MicroPulse TSCPC by IRIDEX® is differentiated from other ophthalmic laser therapies because it is a tissue-sparing solution for the treatment of glaucoma. Much of the information in this document is taken from official publications of the Medicare program. The reader is encouraged to…

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Reimbursement for Tests with the OCULUS Pentacam

OCULUS’ Pentacam® and Pentacam AXL® are multipurpose diagnostic instruments for evaluating the anterior segment using tomography. Tomography provides a three dimensional digital picture of the anterior segment from a variety of vantage points. The Pentacam AXL adds another functionality: optical coherence biometry (OCB) for measurement of axial length of the eye. This monograph describes reimbursement…

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Reimbursement for Tests with the OCULUS Keratograph 5M

This monograph describes reimbursement for tests performed with the OCULUS Keratograph® 5M, either alone or as part of another service. The Keratograph 5M is a multipurpose diagnostic instrument for evaluating the anterior segment using topography, photography, and other imaging. The instrument can perform multiple tests, depending on the patient’s and provider’s needs. These tests and…

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Medicare Reimbursement for Melbourne Rapid Fields

This monograph describes reimbursement for visual field (VF) testing with M&S Technologies’ Melbourne Rapid Fields (MRF) software program. This web-based software works on multiple platforms (e.g., laptop, iPad) and in different settings (e.g., in-clinic, at-home). For the purpose of a claim for reimbursement, testing is identified in a number of different ways depending on several…

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External Ocular Photography and AOS Anterior Software

Advanced Ophthalmic Systems (AOS®) Anterior is a software system1 that analyzes images of the exterior part of the eye. The software aims to consistently grade redness of the cornea, conjunctiva, vessels, and eyelid using an automated objective grading scale. The results are accurate and repeatable to aid the clinician in diagnosing and treating the eye.…

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