Ophthalmology
This page is a central location for ophthalmology information, including CMS resources.
Spotlight
- OIG Report (A-05-24-00009), Medicare Improperly Paid Selected Optometrists for Services Provided to Enrollees at Nursing Facilities
- OIG Report (OEI-04-12-00280), Questionable Billing for Medicare Ophthalmology Services
Policy Information
Not all services have a policy associated with them. We will consider Reasonable and Necessary Guidelines in the absence of an LCD, billing and coding article, NCD, or CMS manual instruction that limits coverage.
LCD
Learn more about the LCD development process through the following:
Search for ophthalmology-related LCDs using these available resources:
- LCD Interactive Index Tool
- View active / proposed LCDs on CMS Medicare Coverage Database (MCD)
NCD
Search for ophthalmology-related NCDs using these available tools:
Medical Documentation
For a claim to be valid, documentation must demonstrate compliance with all applicable coverage, coding and billing requirements and substantiate the level of care billed. The following resources are specific to ophthalmology, but may not address all required medical documentation requirements:
Claim Submission and Reimbursement
Additional Information
- View our New FastTrack to Medicare Coverage Policies Tool to locate guidelines
CMS
- 1997 Documentation Guidelines for Evaluation and Management Services
- MLN Booklet MLN906765, Items & Services Not Covered Under Medicare
- New Technology Intraocular Lenses (NTIOLs)
- NCD 10.1: Use of Visual Tests Prior to and General Anesthesia During Cataract Surgery
- CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 260.2
- CMS IOM Pub. 100-03 Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 10.1 and 80
- National Correct Coding Initiative Policy Manual, Chapter 8, Section D
- OIG Report (OEI-04-12-00281), Medicare Paid $22 Million in 2012 for Potentially Inappropriate Ophthalmology Claims
Education
View our wide selection of free, live and on-demand training options:
- View our upcoming Educational Events Calendar
- View On-Demand Learning
Stay Informed
Stay updated on the latest Medicare information with free email subscriptions: