Reimbursement Guidelines for Scanning Computerized Ophthalmic Diagnostic Imaging

This monograph describes reimbursement for scanning computerized ophthalmic diagnostic imaging (SCODI).  There are two distinct tests: SCODI of the anterior segment, which we will call “SCODI-A”, and SCODI of the posterior segment, which we call “SCODI-P”.  SCODI-P has been well-established as a diagnostic test for glaucoma and retinal conditions.  SCODI-A is more recent and is less common, but growing in use. 

Much of the information in this document is taken from official publications of the Medicare program.  However, the reader is encouraged to check with the local Medicare Administrative Contractor (MAC) for additional information and instructions.  In the case of other third party payers, we have used the coding concepts contained in Current Procedural Terminology (CPT) and published by the American Medical Association; diagnosis codes are from International Classification of Diseases (ICD), 9th edition, and ICD-10-CM.  Documentation of a test, 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 current payment rates for the tests, as well as utilization rates.

 

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