Optometry Coding & Billing Alert

Published on Mon Aug 08, 2005 PDF

Prepare to lose up to $11 on B-scans-thanks to a 4.3 percent conversion factor reduction

If your practice is a high-performer of B-scans, your reimbursement outlook is bleak in 2006. Fees for this service take a dive from $124.68 in 2005 to $112.79 in 2006 - a loss of $11.89 per procedure when you report 76512 (Ophthalmic ultrasound, diagnostic; B-scan ...) as the primary code.
 
Optometrists will feel the pinch with other procedures, including A-scans, fundus photography and scanning laser imaging. Eye examination and E/M codes will also fall in reimbursement next year.

Medicare has published its estimated relative value units and conversion factor for 2006, and the results aren't pretty. The proposed RVUs, published in the Aug. 8 Federal Register, indicate that the reimbursement for several common ophthalmic procedures may decrease next year.

Medicare carriers multiply a procedure's RVUs by a standard conversion factor, set every year by CMS, to determine the reimbursement for that procedure, says Karen Rousseau, insurance coordinator for Eye Vision Associates in Lake Ronkonkoma, N.Y. That conversion factor may drop 4.3 percent, from 37.8975 to 36.2679, in 2006, based on estimated figures published in a report, "Estimated Sustainable Growth Rate and Conversion Factor for Medicare Payments to Physicians in 2006."

Submit Comments Online to Medicare

The new conversion factor is only an estimate, the report stresses. "[T]he actual values for 2006 will be based on later data and will be published in the Federal Register by Nov. 1, 2005," the report says.

Medicare will consider comments submitted before 5 p.m. on Sept. 30, 2005. You can submit comments on the proposed rule at www.cms.hhs.gov/regulations/ecomments.

If this estimation proves accurate, however, the following tables show how it will affect some common optometric procedures, based on the proposed RVUs and unadjusted for geographical location: