Optometry Coding & Billing Alert

Published on Sun Sep 19, 2004 PDF

Question: We recently started seeing patients at a skilled nursing facility. Medicare is saying that we can only bill them for the professional component of fundus photography (we use a portable instrument). How can we get the global reimbursement we are entitled to?

Oklahoma Subscriber

Answer: You can get fully reimbursed for seeing an SNF patient - but the money will be coming from two different places. According to CMS, for services with both a professional and technical component, Medicare Part B is only responsible for reimbursing the professional component of services provided to SNF patients. Therefore, you should submit a claim to Medicare for the professional component of the fundus photography, using CPT code 92250-26 (Fundus photography with interpretation and report; professional component).

You should also submit a claim to the SNF with 92250-TC (... technical component). Since the SNF receives increased funding from Medicare Part A for the patient's complete care, the SNF is responsible for paying you for any covered service you provide.