Medicare Reimbursement for Laser Treatment of the Eye (Topcon Medical Systems)

This monograph describes reimbursement for laser photocoagulation of the anterior and posterior segments of the eye using the Topcon PASCAL® Synthesis™, Synthesis™ TwinStar™, and Streamline™ photocoagulators. PASCAL is an acronym for PAtterned SCAnning Laser.

For the purpose of procedure coding on claims for reimbursement, this laser is identified in a number of different posterior segment treatments, depending on context:

  • retinal photocoagulation,
  • choroidal photocoagulation.

These lasers can, with an optional software upgrade, also treat portions of the anterior segment of the eye (trabecular meshwork) via pattern scanning laser trabeculoplasty (PSLT).

Much of the information in this document is taken from official publications of the Medicare program. The reader is encouraged to check with the local Medicare Administrative Contractor (MAC) for additional information and instructions. For other third party payers, we have used the coding concepts contained in CPT (Current Procedural Terminology), published by the American Medical Association; diagnosis codes are from ICD-10-CM. Documentation of laser surgery, and the medical rationale for it, are key to reimbursement so we describe the required elements in detail.

Since economic analyses are a necessary part of any capital budgeting decision, we incorporated Medicare’s payment rates for these laser treatments, as well as recent Medicare utilization rates.

 

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Provided Courtesy of Topcon Medical Systems, Inc.

 

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