This web page is for Medicare fee-for-service health care professionals who provide ophthalmic services to Medicare beneficiaries.

Physician Fee Schedule Ophthalmology Codes – See Downloads Section below for files

Internet-Only Manuals (IOM)

Program instructions are day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. They are used by CMS program components, contractors, and State survey agencies to administer CMS programs. For many others, they are a good source of technical and professional information about the Medicare and Medicaid programs.  (Scroll to the bottom of this page to the Downloads section; click on Internet-Only Manuals to access links to the IOM specific chapters related to ophthalmology.)

CMS Transmittals, MLN Articles, Job Aids

CMS uses transmittals, MLN Matters Articles, and job aids to communicate new or changed policies or procedures that will be incorporated into the CMS Online Manual System.  (Scroll to the bottom of this page to the Downloads section; click on CMS Transmittals, MLN Matters Articles, and Job Aids to access links to ophthalmology specific transmittals, articles and job aids.)

Federal Regulations and Notices

To access the Federal Regulations and Notices files, see the Downloads section below.

Survey & Certification - Policy & Memos to States and Regions

Details for Doctors of Optometry and/or Ophthalmology serving as Laboratory Directors under CLIA (See Related Links Inside CMS section below for file.)

CMS Rulings

• CMS Ruling CMS-1536-R - Requirements for Determining Coverage of Astigmatism-Correcting Intraocular Lenses that Provide Two Distinct Services for the Patient: (1) Restoration of DistanceVision Following Cataract Surgery, and (2) Refractive Correction of Vision Due to PreexistingAstigmatism, with Less Dependency on Surgical Correction, Eyeglasses, or Contact Lenses (See Download section below for the ruling.)
• CMS Ruling 05-01 - Requirements for Determining Coverage of Presbyopia-Correcting Intraocular Lenses that Provide Two Distinct Services for the Patient: (1) Restoration of Distance Vision Following Cataract Surgery, and (2) Refractive Correction of Near and Intermediate Vision with Less Dependency on Eyeglasses or Contact Lenses (See Download section below for the ruling.)

Management

• Glaucoma Screening – A web page consisting of "What is glaucoma",  "What Medicare covers", and "Other helpful information".  (See Related Links Inside CMS below.)

• Glaucoma Screening Brochure- This two-sided tri-fold brochure provides a basic overview of Medicare's glaucoma screening benefit. (May 2005) (See Downloads section below to download brochure.)

• Age-related Macular Degeneration - Medicare Coverage Advisory Committee (MCAC) Meeting (See Related Links Inside CMS)

National Correct Coding Initiative

The CMS developed the Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.  See the Related Links Inside CMS section below to download the CCI Edits.

• Physician:  Code Range 60000-69999 - Surgery: Endocrine, Nervous Eye and Ocular Adnexa, Auditory Systems
• Physician:  Code Range 90000-99999 - Medicine Evaluation and Management Services
• Hospital Outpatient PPS:  Code Range 60000-69999 - Surgery: Endocrine, Nervous Eye and Ocular Adnexa, Auditory Systems
• Hospital Outpatient PPS:  Code Range 90000-99999 - Medicine Evaluation and Management Services
• NCCI Policy Manual for Part B Medicare Carriers – Chapter 8 and 11 (See Downloads section below.)

New Technology Intraocular Lenses (NTIOLs) - (See Related Links Inside CMS)

Report to Congress

Vision Rehabilitation for Elderly Individuals with Low Vision or Blindness (See Downloads Section below)

Press Center – Medicare News

See the Downloads section below for Ophthalmology related Medicare Press Releases.

Downloads
Physician Fee Schedule Ophthalmology Codes [Excel Zipped, 53KB] Internet-Only Manuals [PDF, 21KB] CMS Transmittals, MLN Articles, Job Aids - Updated 1/29/07 [PDF, 19KB] Federal Regulations and Notices - Updated 1/29/07 [PDF, 24KB] CMS Ruling CMS-1536-R [PDF, 75KB] CMS Ruling 05-01 [PDF 98KB] Glaucoma Screening Brochure [PDF, 242KB] NCCI Policy Manual for Part B Medicare Carriers – Chapter 8 & 11 [MS Word Zipped 163KB] Vision Rehabilitation for Elderly Individuals with Low Vision or Blindness [PDF, 950KB] Press Center - Medicare News [PDF, 21KB]
Related Links Inside CMS
Details for Doctors of Optometry and/or Ophthalmology serving as Laboratory Directors under CLIA Glaucoma Screening NCCI Physician Code Range 60000-69999 and 90000-99999 NCCI Hospital Outpatient PPS Code Range 60000-69999 and 90000-99999 Age-related Macular Degeneration Frequently Asked Questions SNF Consolidated Billing Ambulatory Surgical Center Payment Certification & Compliance – Ambulatory Surgery Centers Hospital Outpatient PPS Physician Fee Schedule Physicians Quality Reporting Initiative New Technology Intraocular Lenses (NTIOLs)
Related Links Outside CMS
Medicare Part D - Dear Health Care Professional Letter Information for Low Income Enrollees in Part D Specialty Society Links Social Security Act:  1861(s)(8) Social Security Act:  1862(a)(7) Social Security Act:  1862(a)(15)(A)

Page Last Modified: 08/09/2007 8:20:44 AM
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