Under Medicare’s new value-based physician payment system, the Centers for Medicare and Medicaid Services evaluates physicians in several areas. Beginning in 2018, this includes resource use. To ensure CMS fairly defines the “peers” to which it compares ophthalmologists, the Academy has won the right for some subspecialists to distinguish themselves from other ophthalmologists in their Medicare enrollment data.
How It Works
The Healthcare Provider Taxonomy Code set classifies and designates various provider types when they submit Medicare and other payer claims for services. Physicians self-designate based on what code set matches closest to their specialty. CMS has now approved voluntary, subspecialist taxonomies for ophthalmic specialties.
- To use the taxonomy, you need to meet the appropriate definition below and be licensed to practice medicine in at least one state in the United States.
- Update your taxonomy in CMS’ National Plan and Provider Enumeration System.
- Medicare has provided feedback on why the usage of taxonomy numbers should be included on submitted claims. The taxonomy code identifies the physician specialty and is used along with the PTAN to identify the correct physician. Delays in claim processing, or denials may take place when not used correctly. Medicare indicates the following loops for electronic submitters:
- Using the rendering provider NPI: Loop 2310B PRV03 or Loop 2420A field PRV03; qualifier PE, segment PRV01
- Using the billing provider NPI: Loop 2000A PRV03; qualifier BI, segment PRV01
Cornea, available for use in claims
To use the taxonomy, you need to be an ophthalmologist who “who specializes in diseases of the cornea, sclera, eyelids, conjunctiva, and anterior segment of the eye.”
Glaucoma, available for use in claims
To use the taxonomy, you need to be an ophthalmologist who “specializes in the treatment of glaucoma and other disorders related to increased intraocular pressure and optic nerve damage. This specialty involves the medical and surgical treatment of these conditions.”
Neuro-ophthalmology available for use in claims
To use the taxonomy, you need to be an ophthalmologist who “manages patients with complex and severe neuro‐ophthalmological disorders. This physician evaluates, treats and studies disorders of the eye, orbit and nervous system having to do with interactions of the visual motor and visual sensory systems with the central nervous system.”
Oculoplastics, available for use in claims
To use the taxonomy, you need to be an ophthalmologist who “specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck.”
Pediatrics available for use in claims
To use the taxonomy, you need to be an ophthalmologist who “specializes in pediatric ophthalmology and strabismus management. The subspecialty includes the medical and surgical management of eye disorders found in children. Some of the more common disorders include amblyopia, strabismus, refractive error, cataract and glaucoma. These disorders may be related to neurological and endocrinological diseases, trauma or aging changes in the extraocular muscles requiring medical, optical and surgical management.”
Retina, available for use in claims
To use the taxonomy, you need to be an ophthalmologist who “ specializes in the diagnosis and treatment of vitreoretinal diseases.”
Uveitis, available for use in claims
To use the taxonomy, you need to be an ophthalmologist who “who specializes in the treatment of intraocular inflammation, scleritis, keratitis, and infectious disorders affecting the eye and inflammatory disorders of the adnexa and/or orbit.”
How to Change Your Taxonomy Code
You can update your taxonomy code by managing your NPI.
- Log in to the NPPES and click on Add Taxonomy
- Choose Provider Type Code 18 (allopathic and osteopathic physicians).
- Keep as primary the ophthalmology taxonomy code (207W00000X)
- Choose as secondary the taxonomy code corresponding to the subspecialty in which you are currently practicing or for which you completed a fellowship program:
a. 207WX0120X for cornea specialist;
b. 207WX0009X for glaucoma specialist;
c. 207WX0109X for neuro-ophthalmology;
d. 207WX0200X for oculoplastics specialists;
e. 207WX0110X for pediatric ophthalmology and strabismus specialist;
f. 207WX0107X for retina specialists;
g. 207WX0108X for uveitis and ocular inflammatory disease.
- Enter the license number(s) and state(s) where you are licensed. You will probably use the same taxonomy code for all of the license entries.
- Click "Save."
Most practice management systems only allow for one taxonomy code to be listed. The ophthalmology taxonomy code should remain in your system to ensure all payers process claims correctly.
Ophthalmologists in a Multi-Specialty Practice
The new codes for subspecialists are a component of ophthalmology taxonomy provider code. Therefore, continue to bill any patients seen within the practice as established patients.