Page 257 - Medicare Benefit Policy Manual

• Comprehensive outpatient rehabilitation facilities (CORFs), critical access
hospitals (CAHs), skilled nursing facilities (SNFs), independent and provider-
based RHCs and free standing and provider-based FQHCs bill for this service
under revenue code 770. CAHs electing the optional method of payment for
outpatient services report this service under revenue codes 96X, 97X, or 98X.

• Hospital outpatient departments bill for this service under any valid/appropriate
revenue code. They are not required to report revenue code 770.

o Calculating the Frequency

• Once a beneficiary has received a covered glaucoma screening procedure, the
beneficiary may receive another procedure after 11 full months have passed. To
determine the 11-month period, start the count beginning with the month after the
month in which the previous covered screening procedure was performed.

o Diagnosis Coding Requirements

• Providers bill glaucoma screening using diagnosis codes for screening services.
Claims submitted without a screening diagnosis code may be returned to the
provider as unprocessable.

o Payment Methodology

• A/B MACs (B)

o Contractors pay for glaucoma screening based on the Medicare physician fee
schedule. Deductible and coinsurance apply. Claims from physicians or other
providers where assignment was not taken are subject to the Medicare limiting
charge (refer to the Medicare Claims Processing Manual, Chapter 12,
“Physician/Non-physician Practitioners,” for more information about the
Medicare limiting charge).

• A/B MACs (A)

o Payment is made for the facility expense as follows:

• Independent and provider-based RHC/free standing and provider-based FQHC -
payment is made under the all inclusive rate for the screening glaucoma service
based on the visit furnished to the RHC/FQHC patient;

• CAH - payment is made on a reasonable cost basis unless the CAH has elected
the optional method of payment for outpatient services in which case, procedures
outlined in the Medicare Claims Processing Manual, Chapter 3, §30.1.1, should
be followed;