Ophthalmology and Optometry Coding Alert

Question: Will Medicare reimburse for the 0025T pachymetry code? We are getting mixed results from private payers and don't know what to expect from Medicare.

Kentucky Subscriber

Answer: Use 0025T a new Category III CPT code in 2002 to bill corneal pachymetry until a CPT II code is issued.

Some Medicare carriers are starting to issue coverage policies for the pachymetry procedure, but there is not yet a national policy. Even if the reason you are performing the pachymetry is not considered a "covered" diagnosis code for your carrier, you should submit the claim. This will help the carrier determine future coverage of the service.

If the reason the service is performed is not considered medically necessary by your carrier, play it safe and get a signed advance beneficiary notice (ABN) from your Medicare patients. On the documentation front, make sure your physician documents an interpretation of the test.