36.4.29.1 Complete Eye ExamsNew Patient
Established Patient
Procedure codes 1-92015, 1-92020, 1-92060, and 1-92100 are not considered for reimbursement separately when submitted with the same date of service as an office visit/eye examination. Note: Procedure code 1-92015 may be considered separately for reimbursement when used to submit the refractive portion of the examination for clients eligible for both Medicare and Medicaid. Refer to "Medicare/Medicaid" . Evaluation and Management Office Visit or Consultation Billed in Addition to the Eye Examination When an E/M office visit or consultation is billed in addition to the eye examination, the most inclusive code is paid and the other denied. Services Billed in Addition to an Evaluation and Management Service or Eye Examination The following services are not reimbursed when billed with an office visit/eye examination on the same date of service. Procedure codes 1-92015, 1-92020, 1-92060, and 1-92100 are considered part of the office visit/eye examination. If no code exists for the additional procedure provided, use the appropriate 1-99201 or 1-99211 visit code. Procedure code 1-92015 may be considered separately for reimbursement if it is used to bill for the refractive portion of an examination for clients who are eligible for both Medicare and Medicaid. Procedure code 1-99173 will deny as part of another procedure/service billed on the same day (e.g., THSteps medical check up or E/M service). Special Ophthalmological Services Reimbursed When Billed the Same Day as General Ophthalmological Services The following special ophthalmological services are reimbursed when billed in addition to a general ophthalmological service, for the same date of service:
A new or established patient office visit or ophthalmological medical examination is denied, if any of the following ophthalmological/ophthalmoscopy services are performed on the same day:
Procedure code 1-92230 is not paid in addition to 1-92235. Valid Diagnosis Codes for Evaluation and Management Services, Consultation Codes, or Medical Eye Examinations Client E/M services, medical eye examinations, and consultations are payable when indicated and billed for the following diagnosis codes:
Eye examinations for aphakia and disease or injury to the eye are not subject to any of the limitations listed above and are payable even if the Medicaid ID form does not have a checkmark under the Eye Exam column. |
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Texas Medicaid & Healthcare Partnership CPT only copyright 2007 American Medical Association. All rights reserved. |
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