Glaucoma Screening - JE Part A

HCPCS/CPT Codes

• G0117 - By optometrist or ophthalmologist
• G0118 - Under direct supervision of optometrist or ophthalmologist

Frequency

Annually

Diagnosis Code

Z13.5 - Encounter for screening for eye and ear disorders

Coverage

Must fall into one category:

• Have diabetes mellitus
• Have family history of glaucoma
• African-Americans aged 50 and older
• Hispanic-Americans aged 65 and older

Exam Requirements

Medicare will pay for glaucoma screening examinations where they are furnished by or under direct supervision in office setting of an ophthalmologist or optometrist, who is legally authorized to perform services under State law

Screening for glaucoma is defined to include:

• A dilated eye examination with an intraocular pressure measurement; and
• A direct ophthalmoscopy examination, or a slit-lamp biomicroscopic examination

Payment

Copayment/coinsurance applies; Deductible applies

Noridian Medicare Portal

Yes - G0117 and G0118

Resources

• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 280.1
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 70
• CMS Medicare Preventive Services