Wiki Packet of Equipment & Program of Care Fees

[Jill1980]

I work in a specialized office as a developmental optometrist. We do something called vision therapy which, for those not familiar, is like physical therapy for the eyes. We help people, mostly children, who have difficulty getting their eyes to work together which can really impact their ability to perform in school and work. It is a very rewarding field where we are able to really make a difference in people's lives. We bill 97xxx rehabilitation codes for these services.

When a patient starts therapy, we charge for 2 items (below) that I believe do not have an appropriate billing code to be able to send to their insurance. I am about to start accepting Medicaid, so I really need to have my ducks in a row. I want to be sure when I have them sign an ABN that states there is no accepted billing code for these items, I have something to back that up and I am a little fuzzy trying to make sure I am correct.

I want to be sure I am correct that there is no accepted billing code for the following items.

1) Packet of Equipment $60

This includes equipment that is used in therapy that is all specific to the vision therapy they will be doing.

2) Program of Care fee - $359

Includes communication with educators (many times we actually go and meet with their teacher) and other professionals on the patient's behalf, 1st day orientation, graduation, and other services that are a part of our program of care.

Thanks,
Jill

 

[vpcats]

I am not familiar with optometry per se but just wanted to add that ABNs are only for Medicare. If you are planning an ABN type, financial waiver for non-medicare patients, check your state's rules regarding this, and perhaps with legal counsel of your institution.

Medicaid is not my forte either but I believe you might be able to not accept patient's Medicaid coverage for just some services, and still participate in the program, as long as you inform them ahead of time and you can document agreement (a.k.a. waiver).

Check your CPT book for counseling type Evaluation and Management codes. There may be something you can use to bill Medicaid for non-supply services and just bill out of pocket for the supplies themselves.