Billing and Coding: Visual Fields

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L34615 Visual Fields. Taped and un-taped visual field testing is considered 1 unit of service for MUE (medically unlikely edits) purposes. MUEs are established by a separate CMS contractor, not WPS GHA. If the claim contains a separate charge for gross visual fields, it will be denied as an incidental service. If the service is performed in a hospital inpatient or outpatient setting, the modifier -26 should be used to indicate the professional component. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare. Claims submitted for visual field examinations performed at unusually frequent intervals may be reviewed to verify that the services were medically reasonable and necessary. For claims submitted to the Contractor or Part B MAC: Claims for Visual Fields Testing services are payable under Medicare Part B in the following places of service: The global services (technical plus professional) may be billed in the following places of service: Office (11), nursing facility (32) and independent clinic (49). The technical component may be billed in the following places of service: Office (11), nursing facility (32), independent clinic (49), federally qualified health center (50) and rural health clinic (72). The professional component may be billed at the following places of service: Office (11), off-campus outpatient hospital (19), inpatient hospital (21), on-campus outpatient hospital (22), emergency room (23), skilled nursing facility (31), nursing facility (32), independent clinic (49) and comprehensive outpatient rehabilitation facility (62).