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Medicare Reimbursement for Selective Laser Trabeculoplasty (Quantel Medical)

FREQUENTLY ASKED QUESTIONS: 

MEDICARE REIMBURSEMENT FOR SELECTIVE  LASER  TRABECULOPLASTY

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Q  Does Medicare cover selective laser trabeculoplasty (SLT)?

A  Yes.  Trabeculoplasty performed with a frequency doubled Nd:YAG laser1. (also known as SLT) is a covered procedure when it is medically necessary and supported in the patient’s medical record.

 

Q  Should I consider SLT as a primary treatment for glaucoma?

A Sometimes.  When a patient cannot tolerate anti-glaucoma medications or cannot comply with instructions for use, then SLT should be seriously considered.2.  When anti-glaucoma meds are not affordable, SLT is a cost-effective alternative.3.  Oftentimes, SLT supplements current medications as an adjunctive therapy to prevent glaucomatous damage.

 

Q  What CPT code do we use to report SLT for glaucoma?

A  CPT code 65855, Trabeculoplasty by laser surgery, one or more sessions (defined treatment series) is used to report the service.  This is the same code used for argon laser trabeculoplasty (ALT) since CPT does not specify the type of laser.  Also, report the location modifiers RT, LT, or 50 as appropriate.

 

Q  What is the Medicare physician reimbursement for SLT?

A  When SLT is performed in the ophthalmologist’s office, the first quarter 2015 national Medicare Physician Fee Schedule allowed amount is $341.46 for participating providers.  No facility fee is reported; the payment includes use of the laser.

When SLT is performed in an ambulatory surgery center (ASC) or hospital outpatient department (HOPD), the surgeon’s Medicare allowable is reduced to $300.70.

Medicare fee schedule amounts are adjusted by local wage indices so actual payment amounts vary.

 

Q  Does Medicare allow a facility fee to an ASC or HOPD for SLT?

A  Yes.  Under current Medicare regulations, 65855 is eligible for a facility fee.  It is paid under APC 247.  The 2015 national ambulatory surgery center (ASC) allowed amount is $188; in the hospital outpatient department (HOPD), the allowable is $443.  Allowed amounts are adjusted by local indices.

 

Q  What is the global surgery period for SLT?

A  CMS assigned CPT 65855 a 10-day global period, so it is classified as a minor procedure for reimbursement purposes.  Most payers agree.

 

Q  Is an office visit billable on the same day as SLT?

A  Sometimes.  The visit on the day of a minor surgery is regarded as part of the global surgery package unless there is a separately identifiable reason for the visit.  If such a reason exists, the exam may be reportable with modifier 25.  If the only reason for the visit is to determine the need for SLT, that visit is not separately billable.  For more information, see our FAQ on this subject.4.

 

Q  Is an office visit billable for a postoperative IOP rise in the treated eye within the 10-day global period?

A  No.  The IOP spike in the treated eye is related to the SLT so the eye exam is considered to be postoperative care.

 

Q  Can I be reimbursed for a repeat SLT on the same eye?

A  Usually.  As a general rule, the effectiveness of SLT can only be evaluated after 1-2 months, which is far beyond the 10-day global period.  When the surgeon believes additional treatment is medically necessary, outside of the global period, it is covered.  Repeat treatments are supported in the literature.5.,6.

 

 Q  What about reimbursement for SLT on the fellow eye during the global period of the first eye?

A  Use modifier 79 with 65855 on your claim to indicate that this procedure is unrelated to the first.  Location modifiers RT and LT are also helpful.  The Medicare allowable remains the same.

 

Q  Can SLT be performed on both eyes on the same day?

A  Yes, although it is not common.  CPT guidelines for bilateral surgery and recent Medicare guidelines for Medically Unlikely Edits (MUE) direct you to report bilateral SLT as 65855-50 with a quantity of “1”.  Under the multiple procedure rules, reimbursement is based on 150% of the Medicare allowable for a single procedure.  Most payers agree with this billing method.

 

1. Selective Laser Trabeculoplasty: 10 Commonly Asked Questions.  Glaucoma Research Foundation.  Link here.

2.  Francis BA, Ianchulev T et al.  Selective laser trabeculoplasty as a replacement for medical therapy in open-angle glaucoma.  Am J Ophthalmol. 2005 Sep; 140(3):524-5.  Link to abstract.

3.  Lee R. and Hutnik CM.  Projected cost comparison of selective laser trabeculoplasty versus glaucoma medication.  Can J Ophthalmol.  2006 Aug; 41(4):449-56.  Link to abstract.

4.  Corcoran Consulting Group. FAQ on Modifier 25.  Link for purchase here.

5.  Lai J and Bournais TE.  Repeatability of Selective Laser Trabeculoplasty (SLT).  Invest Ophthalmol Vis Sci.  2005; 46:E-abstract 119.  Link here.

6.  Hong BK, Winer JC et al.  Repeat selective laser trabeculoplasty.  J Glaucoma.  2009 Mar; 18(3):180-3.  Link to abstract.

 

Provided Courtesy of Quantel Medical  (877) 782-6835

 

Last updated January 26, 2015

 

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. 

 

© 2015 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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