Local Coverage Article

Glaucoma Screening

A53495

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Contractor Information

Article Information

General Information

Article ID
A53495
Original ICD-9 Article ID
A53485
Article Title
Glaucoma Screening
Article Type
Article
Original Effective Date
10/01/2015
Revision Effective Date
02/26/2018
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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Article Guidance

Article Text
Medicare coverage of glaucoma screenings was implemented with the Benefits Improvement and Protection Act of 2000 (BIPA).

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


Medicare covers glaucoma screening for the following persons considered to be at high risk for developing this disease:

  • Individuals with diabetes mellitus

  • Individuals with a family history of glaucoma

  • African-Americans age 50 or over

  • Hispanics-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 one of the high risk groups, as defined above

  • Documentation must support one of the screening 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 optometrist or ophthalmologist Z13.5 (Encounter for Screening for Eye and Ear Disorders)



Coding Information

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
G0117 GLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHED BY AN OPTOMETRIST OR OPHTHALMOLOGIST
G0118 GLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED UNDER THE DIRECT SUPERVISION OF AN OPTOMETRIST OR OPHTHALMOLOGIST

ICD-10-CM Codes that are Covered

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
Z13.5 Encounter for screening for eye and ear disorders

ICD-10-CM Codes that are Not Covered

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
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.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
01/31/2018 02/26/2018 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Glaucoma
  • Screening