Does G0117 require prior authorization?

No, G0117 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0117?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.44.

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.44

Facility

N/A

Non-Facility

N/A

Medical records must document that the beneficiary is a member of a high-risk group to support coverage.
Medical records must document the screening components performed: dilated eye exam with IOP measurement and either direct ophthalmoscopy or slit-lamp biomicroscopic examination.

Medicare covers glaucoma screening for beneficiaries with diabetes mellitus.
Medicare covers glaucoma screening for beneficiaries with a family history of glaucoma.
Medicare covers glaucoma screening for African American beneficiaries age >=50 years.
Medicare covers glaucoma screening for Hispanic American beneficiaries age >=65 years.
A covered glaucoma screening must include a dilated eye examination with intraocular pressure (IOP) measurement and either a direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.

Ask Backwork about documentation requirements, denial risks, or coverage in your state.