Part 6 Filing 3 rd Party Claims. Addressing: Medicare DME Supplier Codes and Modifiers Post-op Glasses (one pair per cataract surgery) Post-op Contact Lenses. Disclaimers.
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Medicare DME Supplier Codes and Modifiers
Post-op Glasses (one pair per cataract surgery)
Post-op Contact Lenses
This information was prepared by the 3rd Party Consultant to the Nebraska Optometric Association, Ed Schneider OD.
To the best of his knowledge, it was current and accurate at the time it was prepared. It is not guaranteed to be error or omission free.
It was prepared as general information to assist doctors and staff, and is not intended to grant rights or impose obligations.
• The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services.
• The Nebraska Optometric Association, and its presenters, agents, consultants and staff makeno representation, warranty, or guarantee that this presentation and/or its contents are error-free or omission-free, and will bear no responsibility or liability for the results or consequences of the information contained herein.
Requires none-degree holding suppliers to obtain accreditation from official accrediting body (initial cost $2500; + ~$1000 per year)
Requires some suppliers to obtain a $50,000 surety bond (costs $500-$1500 per year)
A DMEPOS surety bond is needed by an ODs if s/he
Quentin Quack OD 1/1/05
(Proof of Delivery)
Received by _________________ Date __________
Quentin Quack OD 1/1/05
*Medicare only covers refractive lenses to restore vision normally provided by the natural lens of the eye. (quasi-prosthesis)
One pair of glasses (lenses and frame) after each cataract surgery.
*fees are approximate, current in 2012
Example: Date assumed + date relinquished post-op care
+ # Post-op care days.
Date of Surgery and RT or LT
One of the following ICD-9 codes that justifies the need must be included on the claim :
Primary diagnosis (used by surgeon)
Date of Delivery
V-codes with modifiers
Usual and customary fees charged (based on “per lens”)
Progressive Lenses V2781
PROGRESSIVE ADD V2781 IS DIFFERENCE FROM U&C
Deluxe Frames V2025
DELUXE FRAME V2025 IS DIFFERENCE FROM U&C
RTLT FOR BOTH EYES – UNITS OF TWO
RT FOR OD ONLY; LT FOR OS ONLY– UNITS OF ONE
The following special items are covered only if documented as ordered by the physician (OD or MD)
Add KX modifier for each of these items specifically ordered by the physician:
Add EY modifier for each of these items provided as a patient preference:
Add GA modifier on personal preference items after having patient sight ABN
KX MODIFIER WHEN ORDERED BY DOCTOR
EY MODIFIER WHEN PATIENT PREFERENCE
GA MODIFIER WHEN ABN SIGNED BY PATIENT
GY MODIFIER WHEN NONE COVERED ITEM
We hope this information has been helpful.
Thank you for listening!
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3rd Party Services
Nebraska Optometric Association