Billing Glasses after Cat Sx

chelseasmith

Networker
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If a patient is getting their first pair of glasses after cataract surgery and Medicare is secondary, does the claim still get billed to CGS and is it billed like a Medicare secondary claim that goes to Cahaba with a Medicare Secondary Reason Code of 12 - Working class and OTAF amounts? We've put all that in and the claims still aren't getting paid and I don't know how else to file it.

Thank you
 

Cheezum51

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Dme pos?

Is your office registered as a DME POS provider? Has your office paid the $500+ fee for this registration? If not, you won't be reimbursed for the glasses.

When I had a private practice and before they started charging this ridiculous fee, we would have to file 4-5 times to get reimbursed for post op glasses and, in many cases, still didn't get paid. We then left it up to the patients to file for the glasses, giving them the paperwork and they often got paid without a problem since we became a non participating DME POS provider. Not sure you can still do that.

Tom Cheezum, O.D., CPC
 

chelseasmith

Networker
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We are participating providers of our regional DMERC. We can file and get paid for glasses after cataract surgery, IF Medicare is primary. However, if Medicare is secondary, we do not get paid.
 
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Are you billing each code as Medicare requires or like you would bill any vision or private insurance?
Medicare is VERY strict with how they want the codes.
Example:

v2020 - unit one with z96.1
v2203RTLT- units 2
v2744RTLTKX- units 2
and they have to have the referring doctor on it.

Don't know if this helps you.
Good luck.
 
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