TMPPM 2008 > Texas Medicaid Services > Physician > Procedures and Services

36.4.29.10 Eye Surgery by Incision

The following restrictions apply to vitrectomy and cataract surgeries:

•Procedure codes 2-66500, 2-66505, 2-66600, 2-66605, 2-66625, 2-66630, and 2-66635 are denied as part of another procedure when billed with procedure codes 2-66170 or 2-66172 on the same eye for the same date of surgery.

•When cataract extraction and vitrectomy are billed on the same date of service for clients 8 years of age and under, the vitrectomy will pay at full TMRM allowance and the cataract extraction will pay at 50 percent per multiple surgical procedure payment guidelines.

•Procedure code 2-66020 is denied as part of another procedure when billed with any related eye surgery procedure code.

•Procedure code 2-67036 is reimbursed when billed alone.

•Procedure code 2-67036 is denied as part of another procedure when billed with procedure codes 2-67038, 2-67039, 2-67040, and/or 2-67108.

•Procedure codes 2-67039 and 2-67040 are combined and reimbursed as procedure code 2-67108 when billed by the same provider for the same date of service.

•For clients 8 years of age or younger, the following procedure codes, performed on the same eye, will be considered for payment per multiple surgery guidelines:

•For clients older than 8 years of age, the following procedure codes will be paid when performed on the same eye:

•For clients older than 8 years of age, the following procedure codes will be denied as part of the codes listed above, when performed on the same eye:

Vitrectomy procedure codes 2/F-67036, 2/F-67038, 2/F-67039, and 2/F-67040 are diagnosis-restricted to the following codes:

Cataract procedure codes 2/F-66983, 2/F-66984, 2/F-66985, and 2/F-66986 are diagnosis-restricted to the following codes: