• One of our doctors is stating that we can charge the patient for the optiwave refractive analysis (ORA) when the ultrasound, CPT code 92136 isn’t done. Is this true?


    Question: One of our doctors is stating that we can charge the patient for the optiwave refractive analysis (ORA) when the ultrasound, CPT code 92136 isn’t done. Is this true?

    Answer: No. Optiwave refractive analysis or ORA System™ provides surgeons with real-time measurements of a patient’s eye during their cataract procedures. As a noncovered procedure, it is appropriate to charge patients out-of-pocket only in these three scenarios:

    1. It is part of the premium IOL package.
    2. The patient had given consent to a premium IOL, but intraoperatively the surgeon had to convert to a standard IOL (rare), and
    3. Post-refractive cases

    Facts:

    • The Advance Beneficiary Notice (ABN) is not required for Medicare Part B patients.
    • Practices should develop their own written explanation and associated costs for patients to sign in agreement.
    • Scenarios 2 and 3 are expected to be unusual rather than routine.
    • Inappropriate billing is a complaint filed by patients to the Academy’s ethics department as well as to Medicare contractors and commercial payers.
    • Incorrect billing is violation of payer contracts and perceived as defrauding beneficiaries.