Medicare Reimbursement for Endothelial Cell Count

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Topic: Endothelial Cell Count

Sponsor: Nidek

Updated: 04/24/2018

This FAQ addresses the following:

Does Medicare cover endothelial cell count performed with Nidek’s CEM-530 specular microscope?
Are there any limitations on coverage?
Is the physician’s presence required while the test is being performed?
Will ECC be reimbursed if performed on the same day as an eye exam or another diagnostic test?
What documentation is required in the medical record to support claims for ECC?
How much does Medicare allow for this test?
How often may this test be repeated on a patient?
If coverage of ECC is unlikely or uncertain, how should we proceed?

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The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.

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