By Dr. Mark Margolies
POA President-Elect
It was recently brought to the attention of the POA’s Third Party Center (TPC) that an in-office diagnostic test, InflammaDry, was being reimbursed by Medicare when performed by ophthalmologists, but not optometrists in Pennsylvania. Through a combined effort with our TPC colleagues in New Jersey, led by Dr. Charlie Fitzpatrick, we were able to get Novitas to correct this situation and now optometrists in Pennsylvania, as well as ten other states, are able to bill and get paid for this diagnostic test by Medicare.
Novitas administers the Medicare contract in eleven states and Washington, D.C. These states are Pennsylvania, New Jersey, Maryland, Delaware, Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana and Mississippi.
According to Rapid Pathogen Screening, Inc., InflammaDry is the first and only rapid, in-office test that detects MMP-9, an inflammatory marker that is consistently elevated in the tears of patients with dry eye disease. Using direct sampling microfiltration technology, InflammaDry accurately identifies elevated levels of MMP-9 protein in tear fluid samples taken from the inside lining of the lower eyelid, the palpebral conjunctiva.
In order to be able to perform and bill this test to Medicare, the first step is to apply for a CLIA certificate from CMS. The objective of the CLIA program is to ensure quality laboratory testing. The InflammaDry test is one of several that is exempt from the CLIA program, and therefore the next step is to obtain a CLIA Waiver to perform this test in your office. The needed forms can be found on the CMS.gov website. Click here for helpful information.
The InflammaDry test is billed with CPT code 83516QW. The code 83516 has historically been aligned with complex lab tests not used by eye care professionals. The new CPT code coupled with the QW modifier indicates that a CLIA certificate of waiver is required when used by eye care professionals.
If you are interested in adding this service to your practice, please contact Rapid Pathogen Screening at info@rpsdetectors.com or by calling (877) 921-0080.
