RUC Reviews Diagnostic, Orthoptic Codes to Establish Medicare Values

Three ophthalmic services are getting their payment values queried due to recent growth in claims volume, which came up on a screening.

The Academy presented data gathered with the American Society of Retina Specialists and the American Optometric Association to justify values at the April meeting of the American Medical Association-Specialty Society’s Relative Value-scale Update Committee (RUC). The committee advises the Centers for Medicare & Medicaid Services (CMS) on the code valuations. Any changes would be for the 2023 fee schedule.

The review involves two diagnostic codes, dark adaptation eye exam (CPT 92284) and iris angiography (CPT 92287); the orthoptic training code (CPT 92065); and a new code (CPT 920XX) to describe orthoptic training under the supervision of a physician or qualified health care professional.

The three health care associations presented member survey data on time and intensity of physician work for these procedures that was gathered in March from ophthalmologists and optometrists.

Member surveys and the committee’s valuation process are highly influential on CMS’ decision on values. CMS accepts the committee-recommended values most of the time.

We thank all of our members who completed the valuation survey. The greater the participation, the stronger the data the Academy has to present to the committee and CMS. Because time is a key component of work value, it is critical that members are accurate in their time estimates when completing surveys, including all of the work done in order to avoid shortchanging the value of a procedure.

CMS will announce its decision on the values in summer 2022 as part of the Medicare Physician Fee Schedule Proposed Rule. The values will go into effect Jan. 1, 2023.

The Academy and the retinal and orthoptic community will have an opportunity to comment before the physician fee schedule rule is finalized.

Learn more about the role the committee plays in the payment process.