Ophthalmology and Optometry Coding Alert

CMS' fee schedule update increases reimbursement for several ophthalmic procedures

If Medicare's 2004 Physician Fee Schedule left you feeling shortchanged, a new CMS update may offer some good news: You'll now get double the fee that the original version of the fee schedule allotted for A-scans.
 
On Feb. 20, CMS released Transmittal 105, which corrects mistakes that existed in the original fee schedule. Most notably, Medicare nearly doubled the relative value units (RVUs) assigned to ophthalmic A-scans (76516, Ophthalmic biometry by ultrasound echography, A-scan). Both the nonfacility and facility practice expense RVUs rose from a mere 0.73 to a whopping 1.45. Based on the 2004 conversion factor of 37.3374, this represents a $27 raise (unadjusted for location).
 
The following is a breakdown of the RVU changes -- mostly to ophthalmic radiology codes -- that affect ophthalmologists.

The payment changes took effect Jan. 1, but carriers have until April 5 to implement them.

Transmittal 105 also changes the bilateral status indicator for 92136-26 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation; professional component) from 2 (150 percent payment adjustment for bilateral procedure does not apply) to 3 (the usual payment adjustment for bilateral procedures does not apply). This change allows you to bill for the professional component for each eye when using the IOLMaster device to calculate IOL power.

For the full text of Transmittal 105, visit the CMS site http://www.cms.hhs.gov/manuals/pm_trans/R105CP.pdf.
Visudyne Payment Climbs to 91 Percent

If your ophthalmologist uses verteporfin (commonly known as Visudyne) during ocular photodynamic phototherapy, Medicare has more good news for you. On March 15, Medicare released Transmittal 119, which raises the payment for verteporfin injections (J3395) to 91 percent of the average wholesale price. Previously, Verteporfin injections were set at the default 85 percent. Medicare has set the 2004 payment limit for verteporfin at $1,404.26.

The change took affect April 1, 2004. For the full text of Transmittal 119, visit the CMS Web site http://www.cms.hhs.gov/manuals/pm_trans/r119cp.pdf.