Medicare Reimbursement for Glaucoma Screening

The Benefits Improvements and Protection Act of 2000 (BIPA) provides annual coverage for glaucoma screening for eligible Medicare beneficiaries.  It became effective for services provided on or after January 1, 2002. 

Medicare beneficiaries are eligible for the benefit if they (1) have a family history of glaucoma, (2) are diabetic, or (3) are African-American over the age of 50.  In 2006, a 4th category, Hispanics 65 and older, was added to the list of eligible beneficiaries for glaucoma screening.

This FAQ addresses the following:

1. What is Medicare’s glaucoma screening benefit?
2. Are there any limitations on the benefit?
3. Who can provide and be paid for a glaucoma screening exam?
4. What is included in the exam?
5. Is there a special procedure code to use when billing for the screening exam?
6. Which diagnosis code should we use?
7. What if I diagnose glaucoma or glaucoma suspect during the screening exam?
8. What if I determine that a visual field or other diagnostic test is also needed?  Will I be paid for that as well?
9. If a patient presents with another complaint in addition to asking for the glaucoma screening, then what?
10. How frequently is this test performed?
11. What is the reimbursement for a glaucoma screening exam?
12. Do I collect co-payments and deductibles?
13. I’m not a participating physician.  Is there a limit to what I may charge?

 

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