New graduate optometrists who do not have a provider number already should use the application form for an initial provider number (see below). Application for an initial Medicare provider/registration number for an Optometrist (PDF) When completing this form, you will need to attach a copy of your registration certificate.
Full Answer
Is a Medicare patient's exam billable?
If examination of a Medicare patient is “complaint driven,” it is billable to Medicare but a one physician to one student supervision ratio would be required. The other option is that the billing physician repeats the entire examination.
Does incident to extender apply to students?
“Incident to” or physician extender rationale does not apply, since students are usually not employed or compensated and the regulations are clearly addressing student participation. However, if a student on an externship is employed by the billing physician, the physician extender or the services “incident to” rules may apply.
Can optometry be billed to Medicare?
Examination procedures performed by optometry students cannot be billed to Medicare and some third-party plans, with the exception of the student collected Review of Systems, Past Family and/or Social History. This is the only element of the examination that does not have to be repeated by the billing physician.
Does Medicare recognize student-provided services as billable?
Medicare generally does not recognize student-provided services as billable. (1)
What series of codes do you use for a cursory eye exam?
If it is just a cursory or even detailed eye exam, with no medical care or any sort of counseling, you need to be using 92 series codes. However, if you do follow that up with counseling, then you need to be using the 99 series codes, though caution is advised while using 99 series codes.
What is the code for cataract surgery?
There are specific instances like a patient with mild cataract who could be pseudophakic in the other eye. In such cases, the codes to be used are 92014 and 92015 as it involves an eye examination and refraction. A patient with cataract would need a follow-up only after a year or so as it is just minimally symptomatic. However, a patient with cataract in one eye and who also is pseudophakic in the other needs follow-up after 3 months or even 6 or 12, as the case may be.
What is CPT code?
As a busy optometrist, you need to be thorough with the current procedural terminology (CPT) codes that are used for reimbursement in Medicaid and Medicare. A successful optometrist will need to be conversant with codes falling under 92 and 99 series so that problems with reimbursement are avoided. Moreover, you need to be wary of the watchful eyes of the Health Care Financing Administration (HCFA), the watchdog that looks out for any sort of misuse.
How often do you need to have your intraocular pressure checked for glaucoma?
Glaucoma patients need to have the intraocular pressure (IOP) checked every quarter or once in 4 months. As the optometrist just does a pressure check and offers counseling on medication it qualifies as level 3, and maybe level 4 medical office visit at times. The code to be used for this again is 99213 and 99214.
What is the code for diabetic retinopathy?
However, if diabetic retinopathy is detected during follow-up, the code that needs to be used is 99214. This is because it is more medical care as it involves counseling and advice on medical problems and qualifies as level 4 office medical visit.
How long does it take to follow up on a diabetic?
In such cases, a follow-up after 6 months may be required.
Do optometrists need office visits?
In conclusion, it can be assumed that optometrists need to use office visit codes according to Medicare regulations as they are licensed to do so.
What is the purpose of the optometric survey?
The goal of the survey was to evaluate students' views of their optometric skills as well as their concerns about entering the job market.
Can O.D.s conduct interviews?
Many O.D.s aren't trained to conduct job interviews, so they often fail to gain much insight into a job applicant's personality. The following section will guide you so you can glean as much as possible from your interviews.
How often is 10929 payable?
benefit under items 10921-10929 is payable once only in any 36-month period. If the conditions attached to item 10930 are met, a second contact lens benefit may be payable in a shorter period.
What is MBS 10918?
The MBS describes attendances provided by optometrists using the sequence of initial, second and subsequent, as visits occur in a course of attention.
How long is item 10916?
Unlike other items covering sole or first attendances, item 10916 is not restricted to once only in 36 months for those aged under 65 years or once in 12 months for those aged 65 and over, nor is it limited to patients whose visual or ocular conditions meet specified descriptions—as necessary for items 10912, 10913, 10914 or 10915.
What is a PSR in Medicare?
Professional Services Review was established to protect the integrity of Medicare and the Pharmaceutical Benefits Scheme. Details of the processes involved where there is investigation of what is suspected as being inappropriate practice are detailed at www.psr.gov.au/. A key principle of the PSR Scheme is a system where professionals are given the opportunity to explain their practice to a committee of peers; a peer is appointed after consultation with the relevant professional association as representing the general body of that profession.
How often can I use 10911?
Once the age of 65 is reached, item 10911 applies and this can be used once every 12 months.
What is Medicare practice audit?
Medicare practice audits are a part of the national compliance program and may occur routinely or when a practitioner is identified as having a claiming pattern different from those of their peers. Medicare publishes provider percentile charts that show the number of services billed by peer groups for selected MBS items. Practitioners can use these charts, which are available at
How long is a 10911 consultation?
Consultations of not more than 15 minutes should normally be billed as item 10916 consultations.
