Ophthalmology and Optometry Coding Alert

Question: Are patients undergoing keratoconus workup or contact lens fitting still required to sign an advance beneficiary notice (ABN)? Why is it necessary when Medicare won't pay for it anyway? Answer: According to CMS, "ABNs are not required for care that is either statutorily excluded from coverage under Medicare (i.e., care that is never covered) or fails to meet a technical benefit requirement (i.e. lacks required certification)." You are correct that contact lens fitting (92310, Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia) is never a covered service by Medicare. Therefore, you are not required to obtain the ABN, but you may want to consider voluntarily doing this as a means of notifying the patient of non-coverage and financial responsibility. You are also not required to submit the non-covered service to Medicare unless the [...]