Reimbursement for BlephEx (BlephEx)
FREQUENTLY ASKED QUESTIONS:
REIMBURSEMENT FOR BLEPHEX™
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Q What is BlephEx™?
A BlephEx is a 6-8 minute deep cleaning treatment to remove crust and debris from the eyelids and lashes.1 The BlephEx handpiece, by Rysurg, is a patented hand-held instrument used to precisely spin a medical-grade micro-sponge along the edge of the eyelids and lashes, exfoliating the scurf and bacterial debris thereby helping improve lid hygiene and the overall health of the eyelids.
Q What are the indications for BlephEx?
A BlephEx is used to treat blepharitis, a chronic inflammatory disease of the eyelids. Blepharitis commonly occurs when tiny oil glands located near the base of the eyelashes become clogged.2 Additionally, blepharitis is commonly associated with other ocular surface disease such as dry eye disease and allergic conjunctivitis.3 BlephEx may be considered when other treatments, such as lid scrubs with baby shampoo, hot compresses, and medications have failed or are contraindicated.
Q Where is the procedure performed and who does it?
A BlephEx is an in-office treatment performed by a trained technician under the supervision of an ophthalmologist or optometrist and subject to applicable state laws pertaining to the practice of medicine.
Q How many treatments are needed?
A Blepharitis is usually a chronic condition. The number of treatments for blepharitis will depend on the patient, but could be as often as 2-3 times per year.4
Q What diagnosis codes describe blepharitis?
A Blepharitis is described by ICD-10 codes in the H01.0 series.
Q What CPT code is used to report BlephEx?
A There is no specific CPT code for BlephEx, so CPT instructs billers to use a miscellaneous code. In this case, 67999 (unlisted procedure, eyelid) applies.
Q How much does Medicare allow for BlephEx treatments?
A CMS does not assign RVUs to miscellaneous procedure codes such as 67999, so there is no specific payment rate for BlephEx for Medicare. It is likely that other payers have not assigned a payment rate either.
Q If reimbursement for BlephEx is unavailable or uncertain, how should we proceed?
A Explain to the patient why BlephEx is necessary, and that Medicare or other third party payer will likely deny the claim. Ask the patient to assume financial responsibility for the charge. A financial waiver can take several forms, depending on insurance.
- An Advance Beneficiary Notice of Noncoverage (ABN) is required for services where Part B Medicare coverage is ambiguous or doubtful, and may be useful where a service is never covered. You may collect your fee from the patient at the time of service or wait for a Medicare denial. If both the patient and Medicare pay, promptly refund the patient or show why Medicare paid in error.
- For Part C Medicare (Medicare Advantage), determination of benefits is required to identify beneficiary financial responsibility prior to performing noncovered services. MA Plans have their own waiver processes and are not permitted to use the Medicare ABN form.
- For commercial insurance beneficiaries, a Notice of Exclusion from Health Plan Benefits (NEHB) is an alternative to an ABN.
Q What must billers know about unlisted procedure codes?
A The use of unlisted procedure codes such as 67999 poses administrative challenges.
- Claims are evaluated and an appropriate reimbursement (if any) is made on a case-by-case basis.
- Each claim stands alone; reimbursement for one case does not set precedent for the next.
- There is no published global period.
1 SCOPE Ophthalmics. BlephEx™ Frequently Asked Questions. Accessed 11/05/18.
2 Mayo Clinic. Blepharitis: Definition. Updated March 13, 2015. Accessed 11/05/18.
3 4 Steps To Beating Blepharitis. Optometry Times. July 8, 2016. Accessed 11/05/18.
4 Kekevian, W. BlephEx Treatment Aims to Reduce Blepharitis Damage. Ophthalmology Management. Published 12/1/2013. Accessed 11/05/18.
Provided Courtesy of BlephEx, LLC (800) 257-9787
Last updated November 5, 2018
The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, etc. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any
time following publication.
© 2018 Corcoran Consulting Group. All rights reserved. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a retrieval system, without the written permission of the publisher. CPT is a registered trademark of the American Medical Association.
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