- 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
General Information
Original Medicare does not normally cover routine vision services, such as eyeglasses and eye exams. Medicare may cover some vision costs if associated with other covered expenses (that is, Medicare may cover some vision costs associated with eye problems that result from an illness or injury).
Generally, Medicare covers items or services if they satisfy three basic requirements. The item or service must:
- Fall within a statutorily-defined benefit category;
- Be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body part; and
- Not be excluded from coverage.
Other Eye-Related Medicare-Covered Services
Eye prostheses for patients with absence or shrinkage of an eye due to birth defect, trauma, or surgical removal. Medicare generally covers replacement every five years. Medicare covers polishing and resurfacing.
Note: DME suppliers billing for eyeglasses or contact lenses should submit their claims to their DME MAC.
- Eye exams to evaluate for eye disease for patients with diabetes or signs and symptoms of eye disease.
- Annual examinations by an ophthalmologist or optometrist are recommended for asymptomatic diabetics.
- Certain diagnostic tests and treatments for patients with AMD.
Reviewed 10/13/2023