In November of 2014, the POA sent a letter to the Department of Human Services requesting that optometrists get paid for ten Common Procedural Terminology (CPT) procedure codes. The POA is pleased to report that the department reviewed the optometrist’s Scope of Practice under the Pennsylvania State Board of Optometry and has determined that nine out of ten codes submitted for review will now be payable to optometrists.
For payment purposes, optometrists will be added to procedure codes 65778, 68761, 76510, 76511, 76512, 76516, 76519 and 92025, which already exist on the MA Program Fee Schedule. The department will issue a MA Bulletin to provide further payment information regarding these procedure codes to MA Program-enrolled optometrists. The department expects to issue the bulletin by the end of the first quarter of 2015.
The procedure code 83516, which was not added to the MA Program Fee Schedule, was left out because of the lack of specificity of the tested analyte. The department does not pay laboratories or physicians for this procedure code under the Fee-for-Service delivery system.
If the prescriber determines that the service reflected by procedure codes 65778, 68761, 76510, 76511, 76512, 76516, 76519 or 92025 is medically necessary, the prescriber may request a Program Exception through the 1150 Administrative Waiver Process, depending on the procedure specified in their MA Program Provider Handbook (Section 7.3), which is accessible by this URL: www.dhs.state.pa.us/cs/groups/webcontent/documents/form/s_001840.pdf.
Note: Optometrists rendering vision services under the managed care delivery system should address coding and payment questions to the appropriate managed care organization.
This is just another reminder of how the POA and its Third Party Center continually monitor payer issues and fights for you and your patients.
