Optometry: Look To G, V Codes When Reporting Glaucoma Screens

Why This Topic Matters

Glaucoma screening claims can be denied if coverage criteria, diagnosis support, or beneficiary notice requirements are not handled correctly. This article helps readers understand the Medicare-focused coding and billing considerations that affect whether the screening may be paid.

Article Sections

1. Medicare coverage and high-risk screening eligibility

   Introduces the Medicare context for glaucoma screening and outlines the general patient groups discussed as higher risk. It also sets up the claim-support concepts used throughout the article.

2. Reporting covered glaucoma screenings

   Discusses the Medicare screening reporting framework for optometry and the broad distinction between the screening codes referenced in the article. It also covers the role of supporting diagnosis information on the claim.

3. Example claim support for a covered screening

   Provides a brief billing example showing how a covered screening is documented at a high level. The section illustrates the types of diagnoses and supporting information that may appear on the claim.

4. Certification requirements and ABN use when screening is not covered

   Reviews the state certification point for providing the service and explains the beneficiary notice process when the patient does not meet coverage requirements. It also addresses the general use of a modifier to indicate an ABN is on file.