- Ophthalmology and Optometry Billing Guide
- General Information
- Provider Qualifications
- Local Coverage Determinations
- National Coverage Determinations
- Limitation of Liability (Advance Beneficiary Notice)
- Modifier Usage
- Glaucoma Screening ‒ Preventive Services Coverage
- National Correct Coding Initiative
- Related Content
- Micro-invasive Glaucoma Surgery Update
Glaucoma Screening ‒ Preventive Services Coverage
Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups:
- Individuals with diabetes mellitus;
- Individuals with a family history of glaucoma;
- African-Americans age 50 and older; or
- Hispanic-Americans age 65 and older.
A covered glaucoma screening includes:
- A dilated eye examination with an intraocular pressure measurement; and
- A direct ophthalmoscopy examination, or a slit-lamp bio microscopic examination.
Medical record documentation must show that the beneficiary is a member of one of the high-risk groups. The documentation must also show that you performed the covered screening services. Include the following diagnosis code on your claim: Z13.5.
Billing and Coding for Glaucoma Screening
| Provider | Code | Service/Procedure |
|---|---|---|
| Physician or optometrist | G0117 | Glaucoma screening for high-risk patients. Special screening for neurological eye and ear diseases, glaucoma |
| Under the direct supervision of an optometrist, physician | G0118 | Glaucoma screening for high-risk patients |
| CORF, CAH or SNF | G0117 or G0118 | Glaucoma screening for high-risk patients |
| RHC or FQHC | Paid under the all-inclusive rate, include diagnosis code | Glaucoma screening for high-risk patients |
Reviewed 10/13/2023