Optometry Services at Nursing Facilities: Bill Correctly

In a report, the Office of Inspector General found that Medicare improperly paid optometrists for high-level evaluation and management (E/M) services at nursing facilities. These E/M services aren’t usually billed by optometrists and don’t meet Medicare requirements.

Optometrists visit nursing facilities to provide services like:

• Eye exams for residents with diabetes and those at high risk for glaucoma
• Diagnostic tests and treatment for residents with age-related macular degeneration

During the audit, OIG determined that claims didn’t meet the E/M service criteria for moderate to high complexity level subsequent nursing facility care.

Learn how to bill correctly for optometry services at nursing facilities:

• Medicare Vision Services (PDF) booklet
• Items & Services Not Covered Under Medicare booklet
• Medicare Preventive Services educational tool