Ophthalmology and Optometry Coding Alert

Question: I have a patient who wants to purchase a frame for $200. Medicare allows $74.06. How do I bill the remaining frame cost to the patient? Michigan Subscriber Answer: Medicare will cover glasses only for patients who have undergone cataract surgery. Also, Medicare will pay only for a pair of glasses fitted on standard frames. Should the patient chose to upgrade the frames, he would have to pay for the additional cost. In billing the patient, an advance beneficiary notice (ABN) is required informing him that he needs to pay the difference in the cost for the upgraded frames and the Medicare-approved standard frames. The supplier, on the other hand, is required to submit claims to Medicare noting the purchase of upgraded frames as two separate items on the claim. The supplier will use V2020 (Frames, purchases) for the cost of the "standard frames" (the Medicareapproved amount) and V2025 [...]