CMS Allows Use of Eye Codes for Telemedicine During COVID-19 Emergency

On April 30, 2020, CMS noted that they were expanding the list of codes available for telemedicine during the Public Health Emergency (PHE) due to COVID-19.  Many other specialties also saw their list of codes expanded, but the code series of interest to eye doctors are the familiar “Eye” codes (CPT codes 92002-92014) which are now allowed for billing as telemedicine codes.  Prior to this, eye providers were restricted to Evaluation and Management (E/M) codes (99212-99205) for audio-video exam codes done via telemedicine (TM).

You can link to the new CMS “PHE” website here and then open the link to unzip the file with the list of acceptable codes, which contains two Microsoft Excel files.  Both files show all of the eye codes as available to use.  However, since adequate ophthalmoscopy of the patient is impossible via TM at this time, codes 92004 and 92014 – while included – should not be selected.  A fundus photograph does not substitute for provider-performed ophthalmoscopy.

Codes 92002 and 92012 are possible.  It is still important to document patient consent for billing of the visit.  All of the usual requirements for these codes still apply.  Use modifier 95 and Place of Service (POS) “11” (office) when performing these via TM.  Payment will be equal to that when the exam is done in the office setting for these codes.

Importantly, this must be done via simultaneous audio and video – it is not acceptable to do these exams via audio only; there is a column in one of the two Excel files that must contain “Yes” if a code can be billed via audio but no video.  Of note, CPT codes 99212-99205 also cannot be billed via audio-only technology as they do not have “Yes” in this column either.

CMS allows the use of codes G2012, 99441, 99442, and 99443 for audio-only TM.  The 9944x codes are only allowed during the PHE.

On another note, during the PHE, CMS also increased the payments for the phone-only codes in the series 99441-99443 to accommodate those patients who might not be able to do video.  The Medicare allowable for 99441 now matches 99212, 99442 matches 99213, and 99443 matches 99214.  CMS noted the changes to these allowables are retroactive to March 1, 2020.

Finally, it is important to remember that not all payers follow CMS and they might not allow the eye codes via TM or the increased payments for the phone-only codes.

We are available and happy to assist you with issues such as this and other topics related to eye care during this public health emergency.  Stay safe. (800) 399-6565

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