Does a CPT code have coverage? – Ophthalmic Professional

Find out before you deliver the service.

Some payers have now made it harder to figure out whether a service has coverage. Sometimes we know things our office does will be covered by the patients’ insurances. Cataract surgery is most likely covered, for example, if properly documented. The payer has a published policy, we follow it, and payment comes in as expected.

Unfortunately, it is becoming much more difficult to determine noncoverage than it used to be. MACs no longer have Local Coverage Determinations for noncovered services. These were the policies that listed the codes with no coverage (or payment) so you could rely on that and notify patients accordingly. You knew where you stood.

Now, in some cases, there may be no guidance at all. What then?

This article was published in Ophthalmic Professional’s Coding column, and written by Corcoran’s Senior Consultant, Paul Larson, MBA, MMSC, COMT, COE, CPC, CPMA. To view the entire article in Ophthalmic Professional, click on the link below:

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