| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| 65205 |
Removal of foreign body |
YES |
YES |
29.75 |
47.97 |
| 65210 |
Removal of foreign body, external eye; conjuctival embedded (includes concretions), subconjunctival, or scleral non-perforating |
YES |
YES |
-- |
58.67 |
| 65220 |
Corneal, without slit lamp |
YES |
YES |
30.14 |
49.10 |
| 65222 |
Corneal, with slit lamp |
YES |
YES |
40.05 |
64.50 |
| 65430 |
Scraping of cornea, diagnostic, for smear |
YES |
YES |
60.93 |
97.66 |
| 65435 |
Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) |
-- |
-- |
42.40 |
--
|
| 67820 |
Correction of trichiasis; epilation, by forceps only |
YES |
YES |
32.94 |
46.44 |
| 67938 |
Removal of embedded foreign body, eyelid |
YES |
YES |
146.19 |
224.66 |
68040
|
Expression of conjuctival follicles
|
--
|
--
|
--
|
55.18
|
| 68761 |
Punctual plugs |
YES |
YES |
79.66 |
126.210
|
| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| 68801 |
Dilation of lacrimal punctum (service included surgical procedure only) |
YES |
YES |
63.60 |
102.16 |
76510
|
Ophthalmic ultrasound, diagnostic, B-scan and quantitative A-scan performed during the same patient encounter
|
-- |
-- |
-- |
153.73 |
| 76511 |
Ophthalmic ultrasound |
YES |
YES |
74.92 |
113.70 |
| 76512 |
Cont B-scan (with or without simultaneous A-scan) |
YES |
YES |
71.05 |
107.84 |
| 76514 |
Distinguish glaucoma risk |
YES |
YES |
6.89 |
12.06 |
| 76516 |
Ophthalmic biometry by ultrasound |
YES |
YES |
44.78 |
71.67 |
| 76519 |
With intraocular lens power calculation |
YES |
YES |
46.72 |
75.16
|
| G0117 |
Glaucoma screening for high-risk patients furnished by an OD/MD/DO |
-- |
-- |
25.41 |
41.58 |
| G0118 |
Glaucoma screening for high-risk patients, under the supervision of an OD/MD/DO |
-- |
-- |
15.29 |
27.22 |
| S0620 |
Includes refraction code 92015. Do not bill 92015 separately |
YES |
YES |
35.87 |
93.00 |
| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| S0621 |
S0621 includes refraction code 92015. Do not bill 92015 separately. |
YES |
YES |
34.07 |
83.00 |
| 92002 |
Ophthalmological services; medical examination and evaluation |
YES |
YES |
40.26 |
64.96 |
| 92004 |
Comprehensive, new patient |
YES |
YES |
73.42 |
117.46 |
| 92012 |
Ophthalmological services; medical exam and eval with initiation or continuation of diagnostic and treatment, intermediate |
YES |
YES |
37.03 |
59.16 |
| 92014 |
Comprehensive, established patient, one or more |
YES |
YES |
54.69 |
87.89 |
| 92015 |
Refraction |
YES
|
YES |
40.49 |
70.52 |
| 92020 |
Gonioscopy (separate procedure) |
YES |
YES |
15.50 |
24.25 |
| 92025 |
Computerized corneal topography, unilateral or bilateral, with interpretation and report |
-- |
YES |
-- |
28.25 |
| 92060 |
Sensorimotor exam with multiple measurements |
YES |
YES |
31.22 |
51.40 |
| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| 92070 |
Fitting of Contact lens for treatment of disease (requires auth from Priority Health) |
YES |
YES |
38.54 |
61.35 |
| 92081 |
Visual field exam, unilateral or bilateral |
YES |
YES |
28.42 |
46.45 |
| 92082 |
Intermediate exam (eg. at least 2 isopters on Goldmann perimeter) |
YES |
YES |
36.39 |
60.32 |
| 92083 |
Extended examination |
YES |
YES |
41.98 |
69.20
|
| 92100 |
Serial tonometry (separate procedure) with multiple measurements |
YES |
YES |
49.30 |
79.06
|
| 92120 |
Tonography with interpretation and report |
YES |
YES |
40.91 |
65.49 |
| 92130 |
Tonography with water provocation
|
-- |
-- |
-- |
72.82 |
| 92135 |
Scanning computerized with ophthalmic diagnostic imaging |
YES |
YES |
24.97 |
40.48 |
92136
|
Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation
|
-- |
-- |
-- |
79.01 |
92140
|
Provocative tests for glaucoma, with interpretation and report, without tonography
|
-- |
-- |
-- |
51.51 |
| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| 92225 |
Ophthalmoscopy, extended, with retinal drawing |
YES |
YES |
13.13 |
21.49 |
| 92226 |
Ophthalmoscopy, subsequent with retinal drawing |
YES |
YES |
11.84 |
19.62 |
92235-26
|
Fluorescien angioscophy (includes multiframe imaging) with interpretation and report |
-- |
-- |
-- |
41.38 |
| 92250 |
Fundus photography with interpretation |
YES |
YES |
42.84 |
68.00 |
| 92275 |
Electroculography with interpretation and report |
-- |
-- |
-- |
110.00 |
| 92283 |
Color vision examination |
YES |
YES |
22.18 |
37.91
|
| 92284 |
Dark adaptation examination with interpretation |
YES |
YES |
46.29 |
69.57 |
| 92285 |
External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, slit lamp photography, goniophotography, stereophotgraphy |
YES |
YES |
-- |
41.15 |
92286
|
External ocular photography with interpretation and report, with spcular endothelial microscopy and cell count
|
-- |
-- |
-- |
132.51 |
| 92310 |
Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens both eyes, except for aphakia |
YES |
YES |
50.16 |
87.40 |
| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| *92311 |
Corneal lens for aphakia, one eye |
YES |
YES |
47.37 |
78.29 |
| *92312 |
Corneal lens for aphakia, both eyes |
YES |
YES |
51.03 |
86.10
|
| 92313 |
Corneoscleral lens |
-- |
-- |
43.06 |
-- |
| 92315 |
Prescription of optical and physical characteristics of contact lenses, with medical supervision of adaptation and fitting by independent technician; corneal lens for aphakia, one eye
|
-- |
-- |
-- |
49.62 |
| 92316 |
Prescription of optical and physical characteristics of contact lenses, with medical supervision of adaptation and fitting by independent technician; corneal lens for aphakia, both eyes
|
-- |
-- |
-- |
62.69 |
| 92325 |
Modification of contact lens (separate procedure), with medical supervision of adaptation
|
-- |
-- |
-- |
18.39 |
| 92326 |
Replacement of contact lens |
-- |
-- |
32.83 |
52.66 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
-- |
-- |
23.25 |
-- |
| 92341 |
Fitting of spectacles, except for aphakia; bifocal |
-- |
-- |
26.27 |
-- |
| 92342 |
Fitting of spectacles, except for aphakia; multifocal other than bifocal |
-- |
-- |
27.99 |
-- |
| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| 92352 |
Fitting of spectacle prosthesis for aphakia; monofocal |
-- |
-- |
22.82 |
-- |
| 92353 |
Fitting of spectacle prosthesis for aphakia; multifocal |
-- |
-- |
26.91 |
-- |
| 92370 |
Repair and refitting of spectacles, except aphakia |
-- |
-- |
19.16 |
-- |
| 92371 |
Repair and refitting of spectacles, aphakia |
-- |
-- |
13.78 |
-- |
| 97112 |
Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities** |
-- |
-- |
16.58 |
26.91 |
| 97116 |
Therapeutic procedure, one or more areas, each 15 minutes; gain training (includes stair climbing)
|
-- |
-- |
-- |
22.94 |
| 97530 |
Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes** |
-- |
-- |
16.58 |
27.61 |
| 99201 |
Office/outpatient visit, new |
YES |
YES |
20.88 |
34.68 |
| 99202 |
Office/outpatient visit, new |
YES |
YES |
37.03 |
60.72 |
| 99203 |
Office/outpatient visit, new |
YES |
YES |
55.12 |
90.44 |
| 99204 |
Office/outpatient visit, new |
YES |
YES |
77.94 |
137.65 |
| 99205 |
Office/outpatient visit, new |
YES |
YES |
99.04 |
173.01 |
| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| 99211 |
Office/outpatient visit, established |
YES |
YES |
12.24 |
19.18 |
| 99212 |
Office/outpatient visit, established |
YES |
YES |
21.96 |
35.73 |
| 99213 |
Office/outpatient visit, established |
YES |
YES |
29.93 |
57.96 |
| 99214 |
Office/outpatient visit, established |
YES |
YES |
46.94 |
88.03 |
| 99215 |
Office/outpatient visit, established |
YES |
YES |
68.25 |
119.57 |
| 99241 |
Office/outpatient visit, established |
YES |
YES |
28.63 |
47.52 |
| 99242 |
Office consultation requiring 3 components |
YES |
YES |
52.32 |
88.21 |
| 99243 |
Office consultation requiring 3 components |
YES |
YES |
69.76 |
120.67 |
| Code | Description | Fully Funded Reimb. | Self- Funded Reimb. | Medicaid/ MIChild Reimb. | Medicare Reimb. |
|---|
| 99244 |
Office consultation requiring 3 components |
YES |
YES |
98.39 |
177.13 |
| 99245 |
Office consultation requiring 3 components |
YES |
YES |
127.24 |
220.03
|
| 99251 |
Initial inpatient consultation |
YES |
YES |
-- |
-- |
| 99252 |
Initial inpatient consultation |
YES |
YES |
-- |
-- |
| 99253 |
Initial inpatient consultation |
YES |
YES |
-- |
-- |
| 99254 |
Initial inpatient consultation |
YES |
YES |
-- |
-- |
| 99255 |
Initial inpatient consultation |
YES |
YES |
-- |
-- |
| 99261 |
Follow-up inpatient consultation |
-- |
-- |
-- |
-- |
| 99262 |
Follow-up inpatient consultation |
-- |
-- |
-- |
-- |
| 99263 |
Follow-up inpatient consultation |
-- |
-- |
-- |
-- |
