Page 256 - Medicare Benefit Policy Manual

280.1 – Glaucoma Screening
(Rev. 194, Issued: 09-03-14, Effective: Upon Implementation of ICD-10,
Implementation: Upon Implementation of ICD-10)

A. Conditions of Coverage

The regulations implementing the Benefits Improvements and Protection Act of 2000,
§102, provide for annual coverage for glaucoma screening for beneficiaries in the
following high risk categories:

• Individuals with diabetes mellitus;
• Individuals with a family history of glaucoma; or
• African-Americans age 50 and over.

In addition, beginning with dates of service on or after January 1, 2006, 42 CFR
410.23(a)(2), revised, the definition of an eligible beneficiary in a high-risk category is
expanded to include:

• 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.

The following HCPCS codes apply for glaucoma screening:

G0117 - Glaucoma screening for high-risk patients furnished by an optometrist or
ophthalmologist; and

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

The type of service for the above G codes is: TOS Q.

For providers who bill A/B MACs, applicable types of bill for screening glaucoma
services are 13X, 22X, 23X, 71X, 73X, 75X, and 85X. The following revenue codes
should be reported when billing for screening glaucoma services: