Ophthalmology and Optometry Coding Alert

Question: Thank you for your comprehensive review of the new proposed payment rates for 2019 under the Medicare Fee Schedule proposal. I noticed that you mentioned what the payments would be under the proposal for codes 99202-99205 and 99212-99215, but I didn’t see any payment amounts for a level one E/M service for new and/or established patients. Can you explain what the payments might be for those under the proposal?

Codify Subscriber

Answer: The level one codes could change slightly if the proposal is finalized, but not as dramatically as the codes in levels two through five. CMS is proposing the 2019 payment for 99201 (Office or other outpatient visit for the evaluation and management of a new patient…) to be $44, which is one dollar less than what you’re collecting now.

When it comes to the level one established patient code 99211 (Office or other outpatient visit for the evaluation and management of an established patient…), the proposal suggests raising the payment amount from the current level of $22 to $24, marking a two-dollar increase.

As of press time, CMS is still collecting comments on the proposal, so a final rule is not expected for a few months to reveal whether the payment amounts are definitely going to change. Keep an eye on Ophthalmology and Optometry Coding Alert for updates on the issue.