Ophthalmology/Optometry Billing Guide _____ NHIC, Corp. 2 July 2010 REF-EDO-0015 Version 1.0 The controlled version of … … this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or paper, is uncontrolled and must be destroyed when it has served its purpose. Ophthalmology/Optometry Billing Guide_____ NHIC, Corp. 3 July 2010 REF-EDO-0015 …

Procedure Codes G0117 Glaucoma screening for high risk patients furnished by an Optometrist or Ophthalmologist; G0118 Glaucoma screening for high risk patients furnished under the direct supervision of an Optometrist or Ophthalmologist. Payment Payment for glaucoma screening is based on the Medicare physician fee schedule. Deductible and coinsurance apply. Claims from physicians or other providers where assignment was not taken are subject to the Medicare limiting charge. Note: The above procedures are only paid if there are no other services paid to the provider for the same date of service under the physician’s fee schedule. They are bundled into the service for which payment is made. Hydrophilic Contact Lenses – NCD Hydrophilic contact lenses are eyeglasses and are not covered when used in the treatment of non diseased eyes with spherical ametrophia, refractive astigmatism, and/or corneal astigmatism. However, payment may be made under the prosthetic device benefit for hydrophilic contact lenses when prescribed for an aphakic patient. Prosthetic devices are processed by the Durable Medical Equipment Medicare Administrative Contractor (DME MAC). Hydrophilic Contact Lens for Corneal Bandage – NCD Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as bulbous keratopathy, dry eyes, corneal ulcers and erosion, keratitis, corneal edema, descemetocele, corneal ectasis, Mooren’s ulcer, anterior corneal dystrophy, neurotrophic keratoconjunctivitis, and for other therapeutic reasons. Payment may be made for a hydrophilic contact lens approved by the Food and Drug Administration (FDA) when used as a supply incident to a physician’s service. The lens is not paid separately from the physician’s payment. Intraocular Lenses (IOLs) – NCD An intraocular lens, or pseudophakos, is an artificial lens which may be implanted to replace the natural lens after cataract surgery. Intraocular lens implantation services, as well as the lens itself, may be covered if reasonable and necessary for the individual. Implantation services may include hospital, surgical, and other medical services, including pre-implantation ultrasound (A- scan), eye measurement of one or both eyes….

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