APR 22, 2022
Comprehensive exam and Optos
Since it is not covered by insurance, can we bill the patient for Optos? Can we bill for a comprehensive examination when we use Optos even if we do not dilate the patient?
From the Academy’s Fundamentals training course:
- Non-mydriatic photos are not a substitute for a dilated exam
- If performed as part of the exam, it is included in the payment for the exam and is not separately billable out of pocket to the patient. The practice must absorb the cost. If you rely on the Optos technique rather than dilating the patient, then you must bill a lower-level Eye code or E&M exam.
- The Optos can be used for a noncovered screening exam, in which case the patient is responsible for payment. Obtain an ABN for the Medicare Part B patient or a waiver of liability for other payers.
- With medical necessity, not the result of a screen, non-mydriatic photos may be submitted to the payer as a fundus photo, CPT 92250