Medicare Rules for Intraoperative Optical Coherence Tomography – ZEISS
FREQUENTLY ASKED QUESTIONS:
Medicare Rules for Intraoperative Optical Coherence Tomography
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Q How does iOCT help the surgeon?
A Intraoperative optical coherence tomography (iOCT) with ZEISS RESCAN™ 700 provides high-definition images to monitor progress and verify results without any interruption of the surgery. It works with ZEISS OPMI® LUMERA® microscopes to display real-time OCT in the view of the surgical field and control it with the foot control panel of the surgical microscope.
Q What reimbursement issues affect the use of ZEISS RESCAN 700?
A The primary reimbursement issue is determining who pays for it. Medicare covers medically necessary ophthalmic surgery but does not cover refractive surgery such as corneal relaxing incisions for correction of astigmatism. The charge for refractive surgery, including use of the ZEISS RESCAN 700, is the patient’s financial responsibility.
Q If the ZEISS RESCAN 700 is used in vitrectomy or keratoplasty, who pays for it?
A All of the equipment used in vitrectomy or keratoplasty is covered and reimbursed as part of Medicare’s payment for the facility fee of the ambulatory surgery center (ASC) or hospital outpatient department (HOPD). The type of instruments, techniques or approach used in a procedure is a matter of choice of the surgeon. Like the surgical microscope, iOCT for better visualization during surgery is an incidental part of the procedure and not separately reimbursed for the surgeon or the facility.1 Use of the ZEISS RESCAN 700 during covered surgical procedures is not the patient’s financial responsibility.
Q If the ZEISS RESCAN 700 is used at the time of an evaluation under anesthesia, who pays for it?
A iOCT (92132, 92133, 92134) as a diagnostic procedure is not an inherent or incidental part of an EUA (92018, 92019), nor are these procedure codes bundled in the National Correct Coding Initiative (NCCI) edits. When performed for a medically necessary diagnostic service, iOCT, including the use of the ZEISS RESCAN 700, is separately reimbursed by Medicare or other third party payer.
Q What CPT codes are pertinent for the ZEISS RESCAN 700?
A In CPT, there are 3 distinct codes for diagnostic OCT:
The place of service is not a constraint for coding.
Use of a surgical microscope is reported with +69990, however CPT instructs that 65091-68850 includes “microsurgical techniques requiring use of operating microscope”. This means iOCT is an incidental part of almost all ophthalmic surgery and not separately billed. No separate charge should be made to the patient or third party payer for iOCT used during a surgical procedure.
Q Can iOCT be considered a diagnostic and a surgical service during the same operative session?
A No. It’s one or the other, not both.
1 Federal Register Vol 64 No 140 p 39629, Use of operating microscope (CPT code 69990) July 22, 1999.
Provided Courtesy of ZEISS (800) 358-8258
Last updated September 8, 2021
The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. 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.
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