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Medicare states routine non covered 92012

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    Default Medicare states routine non covered 92012
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    anyone else having this problem? Our MD see's his patietns every two years and will bill the 92012 dx 367.0 medicare states routine dx not covered. In speaking to medicare they state no new guidlines have been made but can not give me an answer on why not covered I can not find LCD on 92012 etc, Any help greatly appreciated

  2. Default
    Quote Originally Posted by lseiter View Post
    anyone else having this problem? Our MD see's his patietns every two years and will bill the 92012 dx 367.0 medicare states routine dx not covered. In speaking to medicare they state no new guidlines have been made but can not give me an answer on why not covered I can not find LCD on 92012 etc, Any help greatly appreciated
    Medicare does not cover routine eye exams. Screening eye exams are not covered. Refractive errors are not covered. These have always been statutorily non-covered services. It's all in the medicare manual.

    If your physician is telling the patients to come back in two years for a check-up, that's great medical practice but it doesn't mean Medicare has to pay for it. It's a self-pay exam, as is refraction if you're doing one.

    Patient needs to come to the ophthalmologist (or optometrist) when they have a medical reason/complaint in order for Medicare to cover. Not just for routine follow ups without medical problems (glaucoma, diabetic retinopathy, keratopathy, etc.)

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