Wiki New code for my practice 99174 input pls!

[ljhaley@gmail.com]

Hi everyone!
My practice administrator is thinking about purchasing the machine to do "Spot vision screening" for our pediatric practice. It's a pretty hefty investment for us. Can anyone tell me if they have had any problems with billing/reimbursement for CPT code 99174? Thank you!!

 

[cmalone999]

99174

We have it and PPO's reimburse between $25 and $30. The code is correct - 99174.

 

[cedwards]

We have it as well and bill 99174. Most payers are reimbursing between $20 and $50!

For the patients who have plans that do not cover the service we have the parents fill out a waiver and they pay upfront for the service.

 

[AKAJBART]

Does this equipment require the Doctor, or can a certified tech perform the vision spot test?

 

[clikens]

iScreen CPT 99174

I am having trouble getting reimbursed for 99174 with Cigna and UHC River Valley insurances. I am billing V72.0 (eye screening) with it. Is there anything else that you can suggest? I have been told by UHC and Cigna that it's covered, but medical necessity is needed. I can't find any coverage decisions that help with this. A modifier 59 won't work either.

Thanks,

Carol

 

[mkj2486]

I have just done some research on this. Many payers have criteria for CPT 99174. One of them is age, which some (like UHC) require that the patient is less than 5.

Aetna requires that the patient is a child 3 years of age, or for screening children ages 4 to 5 years of age who are unable to cooperate with routine acuity screening (e.g., mental retardation, developmental delay, and severe behavioral disorders).

I was unable to find specifics for Cigna, but I am wondering if this is also an age issue.

 

[Peter Davidyock]

Here is a link to the AAP's Bright Futures Screening Schedule:

http://www.aap.org/en-us/profession...rt/Periodicity/Periodicity Schedule_FINAL.pdf

This is the industry standard for peds and most payors follow it.