CMS Allows Use of Eye Codes for Telemedicine During COVID-19 Emergency

Date: May 7, 2020

On April 30, 2020, CMS noted that they were expanding the list of codes available for telemedicine during the Public Health Emergency (PHE) due to COVID-19.  Many other specialties also saw their list of codes expanded, but the code series of interest to eye doctors are the familiar “Eye” codes (CPT codes 92002-92014) which are now allowed for billing as telemedicine codes.  Prior to this, eye providers were restricted to Evaluation and Management (E/M) codes (99212-99205) for audio-video exam codes done via telemedicine (TM).

You can link to the new CMS “PHE” website here and then open the link to unzip the file with the list of acceptable codes, which contains two Microsoft Excel files.  Both files show all of the eye codes as available to use.  However, since adequate ophthalmoscopy of the patient is impossible via TM at this time, codes 92004 and 92014 – while included – should not be selected.  A fundus photograph does not substitute for provider-performed ophthalmoscopy.

Codes 92002 and 92012 are possible.  It is still important to document patient consent for billing of the visit.  All of the usual requirements for these codes still apply.  Use modifier 95 and Place of Service (POS) “11” (office) when performing these via TM.  Payment will be equal to that when the exam is done in the office setting for these codes.

Importantly, this must be done via simultaneous audio and video – it is not acceptable to do these exams via audio only; there is a column in one of the two Excel files that must contain “Yes” if a code can be billed via audio but no video.  Of note, CPT codes 99212-99205 also cannot be billed via audio-only technology as they do not have “Yes” in this column either.

CMS allows the use of codes G2012, 99441, 99442, and 99443 for audio-only TM.  The 9944x codes are only allowed during the PHE.

On another note, during the PHE, CMS also increased the payments for the phone-only codes in the series 99441-99443 to accommodate those patients who might not be able to do video.  The Medicare allowable for 99441 now matches 99212, 99442 matches 99213, and 99443 matches 99214.  CMS noted the changes to these allowables are retroactive to March 1, 2020.

Finally, it is important to remember that not all payers follow CMS and they might not allow the eye codes via TM or the increased payments for the phone-only codes.

We are available and happy to assist you with issues such as this and other topics related to eye care during this public health emergency.  Stay safe.

Recent News

CMS Extends Deadline for MIPS 2023 Data Submission

CMS has extended the data submission period for the Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the ...

Congress Passed bill for MPFS

The recent passing of a partial government funding bill by Congress on March 8 is important to Medicare beneficiaries. This bill includes policies aimed at addressing ...

Change to Processing for Telehealth Services Billed with POS 10

In calendar year (CY) 2024, the Centers for Medicare & Medicaid Services (CMS) issued a change to processing for telehealth services billed with POS 10. ...

Diabetes Cost Measure Misattributed to Ophthalmologists

The American Society of Cataract and Refractive Surgery (ASCRS), the American Society of Retina Specialists (ASRS) and the American Academy of Ophthalmology (AAO), met recently ...

Review Your 2022 MIPS Performance Feedback and Final Scores

The Centers for Medicare & Medicaid Services (CMS) has released the Merit-Based Incentive Payment System (MIPS) performance feedback and final scores for the 2022 performance ...

JZ Modifier Required July 1, 2023

The much-anticipated mandatory reporting of the JZ modifier for Part B Medicare begins July 1, 2023.  The new Medicare policy can be found here.  The ...

Cigna Hits the Brakes on Their New Modifier 25 Policy

Following fierce opposition from the physician community, the insurer Cigna announced today a delay in implementing a policy (PDF) that would have required submitting medical ...

Medical Consulting Group and Corcoran Consulting Group Announce Merger

Springfield, MO, April 27th, 2023. Medical Consulting Group (MCG), a provider of consulting services to ophthalmic practices and companies, and Corcoran Consulting Group (CCG), a ...

IHEEZO Gel gains Medicare Pass-Through

On March 13, 2023, Harrow® announced that the Centers for Medicare & Medicaid Services (CMS) has approved transitional pass-through reimbursement status for chloroprocaine hydrochloride ophthalmic ...

Cigna Change Modifier 25 Policy

As a result of a recent review, Cigna has announced it will require the submission of office notes with claims submitted for evaluation and management ...

Congress makes positive adjustments that affect ophthalmologists

In this Healio Video Perspective from Hawaiian Eye 2023, Kevin J. Corcoran, COE, CPC, CPMA, FNAO, discusses ophthalmic economic and regulatory updates for the year. ...

HHS Extends Covid-19 PHE

On Thursday, October 13, the U.S. Department of Health & Human Services (HHS) Secretary Xavier Becerra extended the nation's COVID-19 PHE for an additional 90 ...

Noridian Changes to Goniotomy LCD

Noridian has made changes to their Goniotomy coverage policy effective October 1st, 2022. It states: “Since there is no specific CPT® code for goniopuncture or ...

2021 MIPS Performance Feedback, 2021 MIPS Final Score, and 2023 MIPS Payment Adjustment Information

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for the 2021 performance year, ...

Telehealth Place of Service Update

With a recent change to telehealth billing, billers need to be aware of an additional Place of Service code. What changed? Effective January 1, 2022, ...

Extension of Telehealth Flexibility

Last week, the U.S. House of Representatives approved legislation to further extend the Medicare telehealth flexibilities first instituted in response to the COVID-19 pandemic. If ...

AETNA No Longer Requiring Prior Authorization for Cataract Surgery

The American Society of Cataract and Refractive Surgery (ASCRS) and American Academy of Ophthalmology (AAO) have spearheaded a year-long effort to remove the policy that ...

2021 MIPS Final Score Preview Now Available

The Centers for Medicare & Medicaid Services (CMS) has opened the Final Score Preview period for the Merit-based Incentive Payment System (MIPS).  You can now ...

Guidance for Coding Goniotomy

Summary:   Two new ophthalmic surgical products have attracted interest from surgeons:  Streamline Viscoelastic Injector® (New World Medical) and IACCESS™ trabecular trephine (Glaukos).  In both cases, ...

CIGNA Changes Their Modifier 25 Policy

As a result of a recent review, CIGNA will require the submission of office notes with all claims submitted with evaluation and management (E/M) CPT ...

CMS Reweights Scoring for Cost Category for Groups in 2021 Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) announced on Monday, April 25th, that ALL eligible MIPS providers will automatically receive re-weighting of the Cost ...

IACCESS™ Trabecular Trephine – How to Code?

Summary:   Glaukos’ new product, the IACCESS™ trabecular trephine, raises interesting coding questions.  Standalone procedures should be reported on a claim for reimbursement as unlisted procedure, ...

Streamline® Viscoelastic Injector – How to Code?

Summary:   New World Medical’s new product, the Streamline® Viscoelastic Injector, raises interesting coding questions.  Standalone procedures with it should be reported on a claim for ...

HHS Extends the Public Health Emergency Waivers

On April 12, 2022, Secretary of Health and Human Services Xavier Becerra again renewed the public health emergency declaration that was initiated at the end ...