Surgeons submit 2 claim forms: • One claim form for surgical procedure • One claim form for the surgeons portion of the post-operative care rSubmit a claim to Medicare with the CPT®cataract surgery code (e.g., 66984) and modifier -55(e.g., 66984-55)
Is cataract post-operative billing easy?
Mar 26, 2021 · Medicare Reimbursement for Post-Operative Services The total post-operative care percentage for ophthalmic procedures has been set at 20% of the surgical fee allowance. In cases where more than one provider furnishes post-operative services, the payment will be divided between the providers based on the number of days for which each provider is …
Does Medicare pay for cataract surgery?
HOW TO BILL for Cataract Surgery Post-op Care. You must provide at least one post-op exam or service before submitting your global charge for the remainder of the 90 day period. Medicare considers you responsible for the patient’s post-operative care rom the “date of transfer” as noted inf the patient’s post-op letter rom PCLI. Bill retroactively to this date—but no more than 90 …
How do you bill Medicare for an Opthamological procedure?
Oct 01, 2019 · Medicare benefits include a conventional intraocular lens (IOL) following cataract surgery, facility supplies and physician services to implant the conventional IOL and one pair of glasses or contact lenses as a prosthetic device post-operative. The following coding and billing guidance is to be used with its associated Local coverage determination.
Does Medicare cover post-cataract eyewear?
Post-operative care-55 •Co-managing provider bills the same CPT code with modifier -55 (eg, 66984-55) for the post-operative care •Cannot bill for the co-managed care until at least one service has been furnished to the patient Cataract Co-Management Billing and Coding After surgery, the surgeon submits a claim for the procedure
How do I bill CPT 66984?
IOL insertion, the correct way to code the procedure is by using CPT code 66984 [Extracapsular cataract extraction removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique ( eg, irrigation and aspiration or phacoemulsification)].
What is the 55 modifier used for?
postoperative managementModifier 55 When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.Feb 8, 2021
Does 99024 need a modifier?
Post-operative visits should be reported with CPT code 99024 when the visit is furnished on the same day as an unrelated E/M service (billed with modifier 24).
How do you bill for cataract surgery?
Billing and Coding Cataract Surgery for Optimal Reimbursement66850 Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration.66920 Removal of lens material; intracapsular.66940 Removal of lens material; extracapsular (other than 66840, 66850, 66852)Jul 20, 2018
How do you bill for post op care only?
The surgeon and the internist should reach an agreement about sharing payment for the surgery. The internist will then bill for post-operative care using the surgical procedure code and modifier -55. If a surgeon has performed the surgery only, the surgeon will bill using the surgical procedure code and modifier -54.
Can modifier 54 and 55 be billed together?
Using Modifiers “-54” and “-55” While doing billing the physician must use the same CPT code for global surgery services billed with modifiers 54 or 55. For surgical care only and post-operative care only, the same date of service and surgical code must be reported.Oct 13, 2020
What is the difference between modifier 24 and modifier 25?
Modifier 24 refers to the evaluation and management services provided to the patient on the day of a surgical procedure unrelated to the procedure itself. Modifier 25 identifies the evaluation and management services as unique services provided on the same day by the same medical professional.Dec 5, 2019
What is a 26 modifier used for?
Generally, Modifier 26 is appended to a procedure code to indicate that the service provided was the reading and interpreting of the results of a diagnostic and/or laboratory service.
Does Medicare pay for 99024?
CPT® 99024 is a Medicare bundled code with zero relative value units (RVUs) and no fee on the Medicare Physician Fee Schedule (MPFS), so you may wonder why CMS is interested in collecting this data. In fact, a Medicare bundled code is reimbursed by Medicare, but not at the time the service is performed.Jan 2, 2018
What is the difference between CPT code 66982 and 66984?
66982: Cataract surgery with insertion of intraocular lens, complex. 66983: Cataract surgery, intracapsular, with insertion of intraocular lens. 66984: Cataract surgery, extracapsular, with insertion of intraocular lens.Feb 1, 2017
Can you bill for a refraction after cataract surgery?
Question: Can refraction be billed during the postoperative period? Answer: Yes. CPT code 92015 Refraction can be billed during the postoperative period. Follow payer guidelines as the patient may be responsible for payment.Jan 28, 2015
Is 66982 covered by Medicare?
What does Medicare allow for 66982? A. Surgeon reimbursement is about 25% higher than the Medicare rate for conventional cataract surgery with IOL (CPT 66984). In 2016, the national Medicare Physician Fee Schedule-allowed amount for 66982 is $806.Aug 1, 2016
Does Medicare cover eyeglasses?
Medicare will rarely cover tint, oversize lenses, A/R coating, polycarbonate, or high index, she adds. So does Medicare also pay for the eye exam? No. Medicare does not cover routine eye exams/refractions for eyeglasses or contact lenses.
Does Medicare cover cataract surgery?
Medicare Coverage of Post-Cataract Eyeglasses, Explained. You may already know this, but it’s worth emphasizing: Medicare does not cover refractions, eyeglasses, or contact lenses for beneficiaries. The exception is for post-cataract surgery or in cases when surgery results in the removal of the eye’s natural lens.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act §1862 (a) (7) excludes routine physical examinations.
Article Guidance
Documentation Requirements:#N#The following documentation must be present in the medical chart:#N#For Visually-Symptomatic Cataract:
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Is DMEPOS a Medicare fee?
All suppliers of Durable Medical Equipment, Orthotics and Prosthetics (DMEPOS), including eyeglasses and contact lenses for postoperative cataract patients, are subject to an enrollment and revalidation fee. The AOA continues to advocate with the Centers for Medicare & Medicaid Services so that doctors who are enrolled in Medicare as physicians should be exempt from this fee.
Does Medicare pay for glasses after cataract surgery?
Medicare will pay for one pair of post-cataract surgery glasses per lifetime per eye after cataract surgery. You also should review any local coverage determinations (LCDs) to find out if there are any local policy stipulations. Additionally, you also may want to call the Durable Medical Equipment Regional Carrier for your area to see if the patient is presently eligible for the glasses. Some LCDs clarify, "If a beneficiary has a cataract extraction with IOL insertion in one eye, subsequently has a cataract extraction with IOL insertion in the other eye, and does not receive eyeglasses or contact lenses between the two surgical procedures, Medicare covers only one pair of eyeglasses or contact lenses after the second surgery. If a beneficiary has a pair of eyeglasses, has a cataract extraction with IOL insertion, and receives only new lenses but not new frames after the surgery, the benefit would not cover new frames at a later date (unless it follows subsequent cataract extraction in the other eye)."
Does Medicare cover eyeglasses?
Medicare will cover one pair of eyeglasses or contact lenses as a prosthetic device furnished after each cataract surgery with insertion of an intraocular lens (IOL). Replacement frames, eyeglass lenses and contact lenses are noncovered.
