AHA Coding Clinic® for HCPCS - 2001 Quarter 3
Screening services now eligible for Medicare coverage
Glaucoma screening services Glaucoma screening services are now eligible for Medicare coverage according to a recent Program Memorandum (PM), Transmittal A-01-105. The Benefits Improvement and Protection ACT of 2000, §102, provides annual coverage for glaucoma screening for eligible Medicare beneficiaries, such as, those with diabetes mellitus or a family history of glaucoma, and certain other individuals found to be at high risk for glaucoma as determined by the Centers for Medicare & Medicaid Services (CMS). Medicare will pay for glaucoma screening examinations where they are furnished by or under the direct supervision of an ophthalmologist or optometrist who...
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Article Overview
This article covers Medicare policy updates affecting coverage for certain preventive screening services, with emphasis on how the changes are reflected in claim submission and outpatient processing guidance. It is aimed at providers, coders, billing staff, and revenue cycle teams who need to know what services are covered, what administrative requirements apply, and which claim-processing considerations affect payment.
Why This Topic Matters
Understanding these Medicare screening coverage changes helps providers and billing teams submit claims correctly and avoid delays, returns, or processing issues for preventive services.
Article Sections
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Glaucoma screening services
Discusses Medicare coverage for glaucoma screening services, including eligibility, provider supervision, timing, and claim submission requirements. It also addresses the related diagnosis reporting and hospital outpatient billing considerations.
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Special handling of Outpatient Payment System (OPPS) claims for screening colonoscopy (HCPCS code G0121)
Describes Medicare outpatient processing guidance for a preventive colonoscopy service, including claim handling timing, retroactive processing, and a required condition code.
What You Will Learn
- Which preventive screening services are affected by the Medicare coverage update
- What broad claim submission and processing requirements apply to the services discussed
- How outpatient claim handling considerations differ for the services covered in the article
- Which administrative references and Medicare guidance documents are mentioned
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Hospital outpatient departments
- Physician practices
- Compliance staff
Codes Discussed
Code Ranges Discussed
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