About this policy
Glaucoma screening was implemented with the Benefits Improvement and Protection Act of 2000 (BIPA) as a Medicare benefit. A glaucoma screening is defined to include: A dilated eye examination with an intraocular pressure (IOP) measurement A direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination High risk individuals for screening may include: Individuals with diabetes mellitus Individuals with a family history of glaucoma African Americans age 50 or over Hispanic Americans 65 or older Glaucoma screening frequency limitations and payment information: Medicare pays for this service annually (i.e., at least 11 full months must have passed following the month in which the last Medicare-covered glaucoma screening examination was performed) Services rendered more frequently than allowed under this screening benefit may require that the beneficiary be given an Advance Beneficiary Notice (ABN) The beneficiary will pay 20 percent as the co-payment or coinsurance after meeting the yearly Part B deductible Medical record documentation requirements: Medical record documentation to support that the beneficiary is a member of a high risk group Documentation must support 1 of the screenings defined: A dilated eye examination with IOP measurement and direct ophthalmoscopic examination, or a slit-lamp biomicroscopic examination Procedure and Diagnosis Code Information: HCPCS Codes HCPCS Code Descriptors/Modifier Diagnosis Code G0117 Glaucoma screening for high risk patient furnished by an optometrist or ophthalmologist Z13.5 (Encounter for Screening for Eye and Ear Disorders) G0118 Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist Z13.5 (Encounter for Screening for Eye and Ear Disorders)
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.