Conditions of Coverage
The regulations implementing the Benefits Improvements and Protection Act of 2000, §102, provide for annual coverage for glaucoma screening for beneficiaries in the following high risk categories:
• Individuals with diabetes mellitus;
• Individuals with a family history of glaucoma; or
• African-Americans age 50 and over.
In addition, beginning with dates of service on or after January 1, 2006, 42 CFR 410.23(a)(2), revised, the definition of an eligible beneficiary in a high-risk category is expanded to include:
• Hispanic-Americans age 65 and over.
Medicare will pay for glaucoma screening examinations where they are furnished by or under the direct supervision in the office setting of an ophthalmologist or optometrist, who is legally authorized to perform the services under State law.
Screening for glaucoma is defined to include:
• A dilated eye examination with an intraocular pressure measurement; and
• A direct ophthalmoscopy examination, or a slit-lamp biomicroscopic examination.
Payment may be made for a glaucoma screening examination that is performed on an eligible beneficiary after at least 11 months have passed following the month in which the last covered glaucoma screening examination was performed.
The following HCPCS codes apply for glaucoma screening:
G0117 – Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist; and
G0118 – Glaucoma screening for high-risk patients furnished under the direct supervision of an optometrist or ophthalmologist.
The type of service for the above G codes is: TOS Q.
For providers who bill intermediaries, applicable types of bill for screening glaucoma services are 13X, 22X, 23X, 71X, 73X, 75X, and 85X. The following revenue codes should be reported when billing for screening glaucoma services:
• Comprehensive outpatient rehabilitation facilities (CORFs), critical access hospitals (CAHs), skilled nursing facilities (SNFs), independent and provider-based RHCs and free standing and provider-based FQHCs bill for this service under revenue code 770. CAHs electing the optional method of payment for outpatient services report this service under revenue codes 96X, 97X, or 98X.
• Hospital outpatient departments bill for this service under any valid/appropriate revenue code. They are not required to report revenue code 770.