- 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
Provider Qualifications
Definition
- Ophthalmologist
- An ophthalmologist is a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) who has completed medical school and an ophthalmology residency that specialized in eye and vision care.
- Optometrist
- A Doctor of Optometry (OD) has completed four years of professional education at a college of optometry. Medicare policy is that a doctor of optometry is considered a physician with respect to all services the optometrist is authorized to perform under state law or regulation.
To be covered under Medicare, the services must be medically reasonable and necessary for the diagnosis or treatment of illness or injury, and must meet all applicable coverage requirements. See CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 16, “General Exclusions from Coverage,” for exclusions from coverage that apply to vision care services, and CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12, “Physician/Practitioner Billing,” for information dealing with payment for items and services furnished by optometrists.
Reviewed 10/13/2023