Reimbursement Issues with Lasering Floaters – Review of Ophthalmology

Date: October 2, 2013

Most vitreous floaters do not require treatment, but for those that do, knowing the appropriate CPT code is a necessity.

This article answers the following questions:

  • How are most patients who suffer with vitreous floaters treated?
  • Are floaters ever treated with surgical intervention? Is laser treatment of vitreous floaters successful?
  • Are there specific documented factors in the patient’s medical record to support laser treatment vs. not treating with lasers?
  • Will third-party payers cover laser treatment for vitreous floaters?
  • Are there any CPT codes describing this treatment?
  • How frequently are these codes utilized? Will the frequent use of these codes attract attention from Medicare?
  • What is the Medicare reimbursement rate for the procedure coded with 67031? Is the physician reimbursed differently if the laser is performed in an ambulatory surgery center or hospital outpatient department?
  • Is there facility reimbursement for an ASC or HOPD in CPT code 67031?
  • Can we expect similar reimbursement rates from other third-party payers?
  • Is there a postop period with CPT code 67031?
  • Are there challenges associated with the unlisted code 67299 if that code applies?
  • If coverage and reimbursement rates are uncertain, should we consider pre-authorization with third-party payers?
  • Is the patient has Medicare, how can we indemnify ourselves when coverage is uncertain?
  • If the patient has commercial insurance, can we utilize an ABN in case insurance denies the claim?

Published in: Review of Ophthalmology's Medicare Q & A column

Written by: Vice-President, Donna McCune, CCS-P, COE, CPMA

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