September 23, 2021 – Centers for Medicare & Medicaid Services (CMS) and Medicare Learning Network (MLN) released an update regarding newly covered glaucoma screening services for FQHC & RHC. Updates include new revenue codes for FQHC & RHC.
Highlights from the Medicare Learning Resources (MLR) fact sheet:
We cover high-risk patients’ annual glaucoma screenings in at least 1 of these groups:
- Patients with diabetes mellitus
- Patients with family history of glaucoma
- African-Americans aged 50 and older
- Hispanic-Americans aged 65 and older
A covered glaucoma screening includes:
- Dilated eye exam with intraocular pressure measurement
- Direct ophthalmoscopy exam, or slit-lamp biomicroscopic exam
Medical record documentation must show the patient’s high-risk group.
Use diagnosis code Z13.5—Encounter for screening for eye and ear disorders, to bill glaucoma screening claims.
Rural Health Clinic (RHC) paid under All-Inclusive Rate (AIR); include diagnosis code— use revenue code 770
Federally Qualified Health Center (FQHC)—use revenue code 770
Table 3. Glaucoma Screening Billing & Coding
|G0117||Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist|
|G0118||Glaucoma screening for high-risk patient furnished under the direct supervision of an optometrist or ophthalmologist|
Table 3’s type of service code is Q. Applicable glaucoma screening service types of bill include: 13X, 22X, 23X, 71X, 73X, 75X, and 85X.
Read the complete fact sheet here.