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Optometry and Ophthalmology

Noridian processes claims following the National Coverage Determination guidelines, which include the following topics:

  • Hydrophilic Contact Lens for Corneal Bandage
  • Photodynamic Therapy including Ocular Photodynamic Therapy (OPT)
  • Photosensitive Drugs
  • Hydrophilic Contact Lenses
  • Scleral Shell
  • Intraocular Photography
  • Refractive Keratoplasty
  • Keratoplasty
  • Endothelial Cell Photography
  • Computer Enhanced Perimetry
  • Phaco-Emulsification Procedure - Cataract Extraction
  • Vitrectomy
  • Intraocular Lenses (IOLs)

Glaucoma Screening

Medicare offers annual coverage for glaucoma screening for beneficiaries in the following high risk categories:

  • Individuals with diabetes mellitus
  • Individuals with a family history of glaucoma
  • African-Americans age 50 and over
  • Hispanic-Americans age 65 and over

Medicare will pay for glaucoma screening examinations where they are furnished by or under the direct supervision in the office setting of an ophthalmologist or optometrist, who is legally authorized to perform the 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 may be made for a glaucoma screening examination that is performed on an eligible beneficiary after at least 11 months have passed following the month in which the last covered glaucoma screening examination was performed.

  • G0117 - Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist
  • G0118 - Glaucoma screening for high-risk patients furnished under the direct supervision of an optometrist or ophthalmologist. 

Resources

Last Updated Jul 27, 2015