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Provider Manual

 
 

Cataract surgery billing

Bill for Priority Health Medicare patients according to Medicare rules.

Ophthalmologist billing for cataract surgery & services

  • Ophthalmologists who perform cataract surgery intraoperative and postoperative services should bill the global surgery code without any modifiers.
  • Modifiers 54, 55 and 56 should only be billed on cataract surgery codes when two ophthalmologists are performing the surgery-related services. Each will be paid according to the global split percentages for preoperative, intraoperative and postoperative care.

Optometrist billing for post-surgical co-management services

Priority Health reimburses optometrists for co-management services following cataract surgery for all products.

Affected CPT codes:

66820, 66821, 66852, and 66983-66985

Surgical services, modifier 54

  • Report surgical services with the CPT code for the cataract surgery and the 54 modifier to indicate that only the surgical component of the global surgical package was provided.
  • Claim will be reimbursed at the appropriate percentage of the fee schedule for surgical services.

Post-operative services, modifier 55

  • Report any post-operative service with the CPT code for the cataract surgery and the 55 modifier to indicate that you perfomed only post-operative services.
  • List the exact dates you performed post-operative care in the notes section of the claim so we can reimburse surgical and post-operative services rendered by each provider.
  • Claim will be reimbursed at the appropriate percentage of the fee schedule for post-operative care.
Last modified: 12/13/2013
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