Not Coded vs Not Covered – Ophthalmology Management

Many practices assume that services without regular CPT codes are automatically non-covered and payable by the patient. That isn’t necessarily the case. What can you do about it?

This article addresses the following questions:

• Aren’t Category III codes and miscellaneous codes non-covered?
• How are we supposed to know if a service is covered or not?
• What if we decide non-coverage is likely and just decline to submit a claim?
• We can get an ABN though, correct?
• What about Medicare Advantage patients?
• How about other payers?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:

https://www.ophthalmologymanagement.com/issues/2022/december-2022/coding-amp;-reimbursement