how to bill procedure code 66984 to medicare for pymt

Provider bills 66984 with modifier 55 Bill the date of the surgery (not the day the provider assumed post-operative care) Include the dates of post-care in the narrative section of the claim MPFS shows the post-operative portion of the payment is 20% of the fee schedule amount for this code

Full Answer

What is the Medicare fee schedule for 66984 with modifier 54?

Provider bills 66984 with modifier 54 The Medicare Physician Fee Schedule shows the pre-op portion of the payment is 10% and the intra-op portion of the payment is 70% of the fee schedule amount for this code, for a total of 80% If the allow amount for the service is $723.83: $723.83 x 80% (0.80) = $579.06 (rounded to the nearest cent)

Does Medicare pay for a 66984 IOL?

Medicare should pay the full fee for the 66984 and they will pay the maximum allowable fee they would pay for a standard IOL with the patient being responsible for the balance for the toric IOL.

What is the CPT code for cataract surgery 66982?

The billing of CPT code 66982, is not related to the surgeon's perception of the surgical difficulty. The use of this code is governed by the need to employ devices or techniques not generally used in routine cataract surgery.

Is there a change in the ICD 10 code 66982?

Depending on which description is used in this article, there may not be any change in how the code displays in the document: 66982 and 66984. The asterisks have been placed back into the ICD-10 Code Group table and the asterisk notes have been moved back to the bottom of the table.

Is CPT 66984 covered by Medicare?

Medicare and most other insurance carriers specifically exclude coverage for the surgical correction of refractive errors, including astigmatism. 66984 with 67036.

Does CPT code 66984 need a modifier?

Modifier 79 For example, if a patient has cataract surgery with an IOL in the right eye (66984-RT), the global period is 90 days, so any other surgery done on this patient's eyes in the next 90 days needs a modifier.

What procedure code is 66984?

66984—Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation.

How much does Medicare reimburse for IOL?

$150Medicare allows you only a modest markup of $25 to $50 above the IOL cost for handling on premium IOLs....Here's how to correctly charge a Medicare patient for a premium IOL.Premium lens cost$1,100Medicare reimbursement for regular IOL- $150$9502 more rows•Apr 3, 2013

What is the difference between 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.

What is the 79 modifier used for?

Modifier 79 is used to indicate that the service is an unrelated procedure that was performed by the same physician during a post-operative period. Modifier 79 is a pricing modifier and should be reported in the first position. A new post-operative period begins when the unrelated procedure is billed.

How do I bill Medicare for post op cataract surgery?

After the optometrist has seen the patient for post-operative care, he/she will submit a claim for the post- operative care provided, using the appropriate CPT Code, i.e, 66984, and Modifier 55.

What is a 54 modifier?

Modifier 54 indicates that the surgeon is relinquishing all of, or part of, the postoperative. care to another physician. ( CMS2) 2. Modifier 55 is billed by the receiving physician, other than the surgeon, who accepts the transfer of care and furnishes postoperative management services.

How do you bill bilateral cataract surgery?

Bilateral Cataract Surgery That being said you will post the surgery 66984 with the -50 modifier and accept the multiple surgery reduction 50% hit on the second eye. Don't bill with -RT(right) and -LT(left) modifiers and add a -59 modifier on the second eye, that's begging for an audit and unbundling.

How do I get Medicare reimbursement?

How to Get Reimbursed From Medicare. To get reimbursement, you must send in a completed claim form and an itemized bill that supports your claim. It includes detailed instructions for submitting your request. You can fill it out on your computer and print it out.

Are premium Iols covered by insurance?

Though Medicare and private insurance generally cover standard cataract surgery with monofocal implants, they do not cover the additional cost of refractive cataract surgery, which includes a premium IOL and/or a laser.

What is CPT V2788?

The definition of the new code V2788 is "Presbyopia- correcting function of an intraocular lens." The new code is effective for dates of service on or after January 1, 2006.

Coding Complex Cataract Surgery With Confidence

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When does a practitioner bill for postoperative care?

When a transfer of postoperative care occurs, the receiving practitioner may not bill for any part of the global service until he/she has provided at least one service. Once the practitioner has seen the patient, that practitioner may bill for the period beginning with the date on which he assumes care of the patient.

Why can't a patient undergo surgery?

The patient’s quality of life is not compromised. The patient cannot safely undergo surgery because of coexisting medical or ocular conditions. An informed consent cannot be obtained from the patient or surrogate decisionmaker. Appropriate postoperative care cannot be arranged.

This includes facility and doctor fees. You may need more than one doctor and additional costs may apply

This is the “Medicare approved amount,” which is the total the doctor or supplier is paid for this procedure. In Original Medicare, Medicare generally pays 80% of this amount and the patient pays 20%.

This includes facility and doctor fees. You may need more than one doctor and additional costs may apply

This is the “Medicare approved amount,” which is the total the doctor or supplier is paid for this procedure. In Original Medicare, Medicare generally pays 80% of this amount and the patient pays 20%.

How much is the IOL for cataract surgery?

Keep in mind that the ASC is receiving the $150 for the IOL used in the surgery from Medicare as part of the cataract extraction CPT code, so that amount must be subtracted from the amount charged to the patient. Medicare allows only a modest mark-up on the IOL for handling ($25-$50 maximum). Medicare does not allow patients to be charged ...

Does Medicare reimburse ASCs for premium lenses?

First, even though Medicare does not reimburse ASCs any more for the use of premium lenses in their cataract cases than they do for regular IOLs, the ASC still needs to indicate on their Medicare claim form that a premium lens was used in the case. Bill the premium lenses using the V2788 code for PC IOLs or the V2787 code for an AC IOL.

Can an ASC claim an IOL?

Medicare considers it to be a false claim for the ASC to submit a cataract extraction claim for which they are receiving payment for the IOL when the ASC is not supplying the IOL for the case. Medicare does not allow ASCs to reimburse physicians for IOLs if the IOL was supplied by the physician in a cataract case.

Does ASC collect money from IOL?

An ASC must collect the money related to the IOL directly from the patient. When an ASC charges a patient for the difference between the $150 Medicare reimburses the ASC for the IOL and the full lens cost of a premium lens, it could be a compliance issue. What an ASC charges Medicare patients for a premium lens must be handled correctly ...

Global package

Physicians who perform the surgery and furnish all the usual pre- and post-operative work should bill for global surgical care by using the proper CPT surgical code (s). In this situation physicians should not bill separately for visits or other services that are included in the global package. No modifier is necessary.

Co-management

Occasionally a physician must transfer the care of the patient during the global care period. In these instances, the use of a modifier will be necessary to distinguish who is providing care for the patient. Novitas expects these instances to be rare.

Reasons for splitting care

The operating surgeon is unavailable after surgery and the patient's postoperative care has to be managed by another physician.

Transfer of postoperative care is not covered if

The operating surgeon is available, and he/she can manage other patients postoperatively, unless the patient voluntarily wishes to be followed postoperatively by another provider.

Surgical care

Specific billing guidelines must be followed when the surgical procedure and post-operative care is split between different physicians. Modifiers 54 and 55 are used to indicate two different physicians are rendering the surgical care and post-operative management services.

Payment calculation

Provider performed pre- and intra-operative care only for procedure code 66984:

Documentation requirements

The surgeon should write usual operative note and the physician providing postoperative care should document appropriate follow-up care notes.

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: The following documentation must be present in the medical chart: 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.

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Billing Correctly

Medicare Reimbursement to ASCS For IOLs

• When ASCs bill the 66984, 66982 or other cataract extraction procedure code to Medicare, those codes include the insertion of an IOL in the cataract procedure, and the payment of the cataract CPT code to ASCs includes a $150 allowance as payment for a regular IOL. That does not change when premium lenses are used in the case. ASC facilities are sti...

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Compliance Issues Involved with Using Premium Lenses