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Medicare Re-valuing Vitrectomy Codes

CMS previously conducted a survey of cataract surgery costs, and the result was a significant drop in the allowable for cataract codes.  Now CMS is looking at vitrectomy codes.

Please note this communication from the American Academy of Ophthalmology.  If you wish to participate in the survey, contact the AAO as soon as possible.  See below.

 

Member Assistance Needed in Determining Medicare Vitrectomy Code Values

The Academy and the American Society of Retina Specialists are seeking input to determine and/or justify Medicare pay for six retina surgical codes. The Centers for Medicare and Medicaid Services has targeted these codes as misvalued and asked that they be reviewed to help determine provider pay in 2014. At the request of the agency, the Academy and ASRS will conduct a survey of the physician work values for vitrectomy:

  • 67036 Vitrectomy, mechanical, pars plana approach
  • 67039 Vitrectomy, with focal endolaser photocoagulation
  • 67040 Vitrectomy, with endolaser panretinal photocoagulation
  • 67041 Vitrectomy, with removal of preretinal cellular membrane (eg, macular pucker)
  • 67042 Vitrectomy, with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas, or silicone oil)
  • 67043 Vitrectomy, with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas, or silicone oil) and laser photocoagulation

Physicians selected to participate in the American Medical Association/Specialty Society Relative Value Scale Update Committee survey will get an email from AAOdc.org@softekdc.com. Physicians who receive the survey must complete it by June 17. Physicians who perform any of the above services and are interested in completing a survey should contact Kelsey Lang at klang@aaodc.org.

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