Primary Care Coding Alert

Question:

California Subscriber

RVUs are based on the Medicare Physician Fee Schedule; if a CPT procedure code does not have an RVU, it usually is because Medicare does not cover the service. Or, even if CMS does cover the service, some of your other payers might not. For example, the California worker's compensation program does not follow RVUs in general, so it has its own codes and payment schedule.

Options: Check some of your other payers' fee schedules to determine an appropriate price for the procedure. Some might allow separate payment, while some could consider procedures such as 99172 (Visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision [may include all or some screening of the determination{s} for contrast sensitivity, vision under glare]) included in ��" and not separately payable from ��" preventive medicine, E/M, or other ophthalmology services.