Practice Management Considerations for the Icare® HOME Tonometer

FREQUENTLY ASKED QUESTIONS: 

PRACTICE MANAGEMENT CONSIDERATIONS FOR THE ICARE® HOME TONOMETER

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Q:  What is the Icare® HOME tonometer?

A:   The Icare® HOME tonometer is a hand held device that a trained and certified patient can use to safely and reliably measure intraocular pressure (IOP) at home on an occasional basis without local anesthesia.  It is FDA cleared[1] and available in the US.[2]  Compared with Goldmann applanation tonometry (GAT), the Icare® HOME measurements agreed with GAT within 5 mm Hg in 91% of patients.  The mean difference between Icare® HOME and GAT was -0.33 mm Hg (SD 3.11).  Most patients (84%) can be certified to use the Icare® HOME, but not all, and some patients (6%) have difficulty using the device even after training.[3]

 

Q:  How is a patient trained and certified for the Icare® HOME tonometer?

A:  An ophthalmologist’s or optometrist’s medical assistant provides instruction to the patient on the use of the Icare® HOME tonometer.  Then, the patient practices self-tonometry under the gaze of the medical assistant.  Once proficiency is established, the patient is certified.

 

Q:  How is IOP recorded by the Icare® HOME tonometer?

A:  The Icare® HOME tonometer captures the IOP measurements but does not display them.  The measurements stored within the Icare® HOME unit can only be downloaded and read by a physician equipped with a suitable computer and Icare® LINK software.

 

Q:  What are the indications for self-tonometry?

A:  Self-tonometry is indicated to determine whether IOP monitoring outside of normal office hours adds clinically useful information.[4]  Some potential motivations for self-tonometry include: suspicion of diurnal variability, immediate postoperative use, and to measure the impact of self-administered medication.

 

Q:  Does an Icare® HOME tonometer fall within the definition of durable medical equipment (DME)?

A:  Yes.  DME is equipment that: 1) can withstand repeated use; 2) is primarily and customarily used to serve a medical purpose; 3) is not useful in the absence of illness or injury; and 4) is appropriate for use in the home.[5]

 

Q:  Does a DME Medicare Administrative Contractor pay for a brief rental of an Icare® HOME tonometer?

A:  No.  DME that is only rented for a few days is not covered by Medicare; long term rentals on a monthly basis may be covered.

 

Q:  What CPT code describes self-tonometry?

A: CPT is a list of descriptive terms and identifying codes for reporting medical services performed by physicians or other qualified health care professionals.[6]  Self-tonometry is performed by the patient – not the physician.  No CPT code exists; a claim for professional services should not be filed.

A potential source of confusion is CPT 92100 (serial tonometry).  This physician-administered test is not self-tonometry.

 

Q:  Is there a Health Care Procedure Coding System (HCPCS) code to describe the Icare® HOME tonometer?

A:  At present, HCPCS does not contain a code to describe a home tonometer.  The default HCPCS code is A9999 (Miscellaneous DME supply or accessory, not otherwise specified).

 

Q:  How do we obtain payment for the rental of an Icare® HOME tonometer?

A:  Beneficiaries are financially responsible for noncovered items and services.  A modest charge applies to the short term (i.e., a few days) rental of the Icare® HOME tonometer.  A fully refundable safety deposit on the instrument may also apply.

 

Q:  If coverage of DME is unlikely or uncertain, how should we proceed?

A:  Explain to the patient why a short term rental of the Icare® HOME tonometer 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.[7] 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.
  • For commercial insurance beneficiaries, a Notice of Exclusion from Health Plan Benefits (NEHB) is an alternative to an ABN.

 

 

[1]   Icare.  News and Events.  March 22, 2017.  Link here.  Accessed 03/27/17.

[2]   FDA.  510(k) premarket approval.  April 19, 2016.  Link here.  Accessed 03/27/17.

[3]  Mudie, L, LaBarre, S, et al.  Clinical Performance Study for Self-use of an Intraocular Pressure Measuring Device: the Icare Home Device (TA022).  Annual meeting of the American Glaucoma Society.  March 2016

[4]  Barkana Y, Anis S, et al. Clinical utility of intraocular pressure monitoring outside of normal office hours in patients with glaucoma. Arch Ophthalmol. 2006 Jun;124(6):793-7. Accessed 03/17/16.

[5]   Medicare Benefit Policy Manual, Chapter 15 §110.1. Definition of Durable Medical Equipment. Accessed 03/21/16.

[6]  American Medical Association Current Procedural Terminology, 2017

[7]  Medicare Claims Processing Manual Chapter 1 §60. Provider Billing of Non-covered Charges on Institutional Claims. Accessed 03/21/16.

 

Provided Courtesy of  Icare USA, Inc. (888) 422-7313

Last updated March 27, 2017

The reader is strongly encouraged to review federal and state laws, regulations, code sets (including ICD-9 and ICD-10), and official instructions promulgated by Medicare and other payers.  This document is not an official source nor is it a complete guide on reimbursement.  The reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.

© 2017 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.

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