Ophthalmology Shifts Focus to Uniform Implementation of Taxonomy Codes by Private Insurers

With new ophthalmic subspecialty taxonomy codes now a part of the Medicare program, the Academy is leading ophthalmology’s effort to urge private insurers to follow suit. The Academy and subspecialty groups are making a compelling patient-centered case to insurance carriers nationwide. We’re citing the benefits of properly identified specialists, which ensure better patient access to quality care and network adequacy. We’re partnering with the American Glaucoma Society, the Retina Society, the Macula Society, the American Uveitis Society, the American Society of Retina Specialists and the American Society of Ophthalmic Plastic and Reconstructive Surgery for this effort. 

Currently, carriers risk the inadvertent omission of subspecialties like glaucoma and retina by lumping all ophthalmologists into a single group before determining who is in-network. 

Private insurers are not required to adopt taxonomy codes for subspecialists but many do use them to some degree. The Academy believes that their adoption of these designations will ensure adequate numbers of physicians within health plans. It would also ensure beneficiary access for those whose diseases and conditions may require ophthalmologists with additional subspecialized training.