Practice Management Considerations for LipiView®, DMI, and LipiFlow® (TearScience)

TearScience created LipiView, Dynamic Meibomian Imaging (DMI), and LipiFlow so patients with evaporative dry eye disease (DED) exacerbated by meibomian gland dysfunction (MGD) can be identified and treated.  LipiView and DMI provide the clinician with diagnostic tools for assessing respectively the adult tear film and the meibomian glands.  LipiFlow Thermal Pulsation provides a means to open obstructed passage ways in the eyelid so that lipids produced by the meibomian glands can reach the tear film and mitigate aqueous evaporation.

New technologies pose challenges to physicians and patients alike because Medicare and other third party payers are reluctant to cover them until they are thoroughly vetted in the scientific literature, widely accepted in the medical community, and commonly performed for the FDA approved indication(s).  So, at this time, many payers have designated LipiView and LipiFlow as “experimental and investigational” and therefore not covered; the patient is financially responsible for the professional fee.  Some policies refer only to LipiFlow while others refer to both LipiFlow and LipiView.  Our experience to date with claims for DMI has demonstrated that third party payers deny them for a variety of reasons.

Much of the information in this document is taken from official publications of the Medicare program, including the Centers for Medicare and Medicaid (CMS) and the Medicare Administrative Contractors (MAC).  However, the reader is encouraged to check with the local MAC for additional information and instructions.  In the case of other third party payers, we have used the coding concepts contained in CPT and published by the American Medical Association; diagnosis codes are from International Classification of Diseases (ICD), 9th edition, and ICD-10-CM.  For noncovered pro-cedures, documentation of beneficiaries’ understanding and acceptance of financial responsibility is critical, so we describe the required financial waivers in detail.

 

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