LCD Reference Article Article

Glaucoma Screening

A53495

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

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General Information

Source Article ID
N/A
Article ID
A53495
Original ICD-9 Article ID
Not Applicable
Article Title
Glaucoma Screening
Article Type
Article
Original Effective Date
10/01/2015
Revision Effective Date
11/21/2024
Revision Ending Date
N/A
Retirement Date
N/A

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Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

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Article Guidance

Article Text

Glaucoma screening was implemented with the Benefits Improvement and Protection Act of 2000 (BIPA) as a Medicare benefit.

A glaucoma screening is defined to include:

    • A dilated eye examination with an intraocular pressure (IOP) measurement
    • A direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination


High risk individuals for screening may include:

    • Individuals with diabetes mellitus
    • Individuals with a family history of glaucoma
    • African Americans age 50 or over
    • Hispanic Americans 65 or older


Glaucoma screening frequency limitations and payment information:

    • Medicare pays for this service annually (i.e., at least 11 full months must have passed following the month in which the last Medicare-covered glaucoma screening examination was performed)
      Services rendered more frequently than allowed under this screening benefit may require that the beneficiary be given an Advance Beneficiary Notice (ABN)
    • The beneficiary will pay 20 percent as the co-payment or coinsurance after meeting the yearly Part B deductible


Medical record documentation requirements:

    • Medical record documentation to support that the beneficiary is a member of a high risk group
    • Documentation must support 1 of the screenings defined:
      • A dilated eye examination with IOP measurement and direct ophthalmoscopic examination, or a slit-lamp biomicroscopic examination


Procedure and Diagnosis Code Information:

HCPCS Codes HCPCS Code Descriptors/Modifier Diagnosis Code
G0117 Glaucoma screening for high risk patient furnished by an optometrist or ophthalmologist Z13.5 (Encounter for Screening for Eye and Ear Disorders)
G0118 Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist Z13.5 (Encounter for Screening for Eye and Ear Disorders)



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Coding Information

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ICD-10-CM Codes that Support Medical Necessity

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Group 1 Codes
Code Description
Z13.5 Encounter for screening for eye and ear disorders
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Revenue Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
11/21/2024 R5

Under Article Text revised the first sentence to “Glaucoma screening was implemented with the Benefits Improvement and Protection Act of 2000 (BIPA) as a Medicare benefit.” Revised the sentence “Medicare covers glaucoma screening for the following persons considered to be at high risk for developing this disease” to “High risk individuals for screening may include.” Revised the sentence “Medical record documentation to support that the beneficiary is a member of one of the high risk groups, as defined above” to “Medical record documentation to support that the beneficiary is a member of a high risk group.”

02/26/2018 R4 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
04/14/2016 R3 Under Article Text changed "and" to "or" in the 5th and 6th bullet and corrected grammatical errors.
10/01/2015 R2 Under Associated Documents, Statutory Requirements, added the web site links to Title XVIII of the Social Security Act §1862(a)(1)(A) and Title XVIII of the Social Security Act §1833(e).
10/01/2015 R1 Added HCPCS/ICD-10 codes from Article Text to the HCPCS/ICD-10 Coding section.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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Public Versions
Updated On Effective Dates Status
11/12/2024 11/21/2024 - N/A Currently in Effect You are here
01/31/2018 02/26/2018 - 11/20/2024 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Glaucoma
  • Screening