Optometry and Ophthalmology

Noridian processes claims following National Coverage Determination (NCD) guidelines which include the below 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 optometrist or ophthalmologist
  • G0118 - Glaucoma screening for high-risk patients furnished under direct supervision of optometrist or ophthalmologist


Last Updated Mar 08, 2018

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.