Ophthalmology and Optometry Coding Alert

Question: We can’t find a code in CPT^® for glaucoma screenings for Medicare patients. How do we report this?

Codify Subscriber

Answer: Codes do exist for these services, but you will find them in the HCPCS manual rather than in CPT®. When you perform a glaucoma screening on a high-risk Medicare patient, you’ll report either G0117 (Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist) or G0118 (Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist).

The difference between G0117 and G0118 is that the physician performs the service described by G0117, while the physician supervises another clinical staff member in the code described by G0118. To qualify for G0118, the services must be furnished under the direct supervision of an ophthalmologist or optometrist. Direct supervision means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. Often this is performed by a tech, but keep in mind that state laws dictate who can legally perform glaucoma screenings in each state.

Bottom line: If the doctor is out to lunch, on vacation, out sick, or otherwise not available in the office suite, you cannot report a service as if it was furnished under the doctor’s direct supervision.

Keep in mind that these codes can only be billed once a year, but only for patients who do not currently have a glaucoma diagnosis. These are used for screening patients at high risk for the disease but who do not yet have it.