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Ophthalmology and Optometry Coding Alert

Medicares Routine Services Policy

Published on Sun Oct 01, 2000

The following is an excerpt from the routine services policy for Medicare:

The coverage of services rendered by an ophthalmologist is depending on the purpose of the examination rather than on the ultimate diagnosis of the patients condition. When a beneficiary goes to an ophthalmologist with a complaint or symptoms of an eye disease or injury, the ophthalmologists services (except for eye refractions) are covered regardless of the fact that only eyeglasses were prescribed. However, when a beneficiary goes to his/her ophthalmologist for an eye examination with no specific complaint, the expenses for the examination are not covered even though as a result of such examination the doctor discovered a pathologic condition.
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