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Ophthalmology and Optometry Coding Alert

Reference Tip:

Check Medicare's Fee Schedule for Bilateral Codes

Published on Tue Oct 14, 2003

Most CPT codes in the ophthalmology section are considered unilateral by Medicare; however, some are bilateral.
Check the Medicare Physician Fee Schedule database where a bilateral indicator of "0" means the 150 percent payment adjustment does not apply. The code covers payment for one eye only. If surgery is performed on both eyes, the unilateral code must be billed twice. Most Medicare carriers allow modifier -50 (Bilateral procedure) on a single line item. If the status is bilateral, the fee is the same whether the procedure is performed on one eye or both.
 
The American Academy of Ophthalmology's Web site (www.aao.org) is the best resource for determining the bilateral status of any code, but if you aren't an AAO member, you can go to the CMS Web site and perform a search (http://www.cms.gov/physicians/mpfsapp/default.asp).
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