SEP 22, 2021
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:
- It is part of the premium IOL package.
- The patient had given consent to a premium IOL, but intraoperatively the surgeon had to convert to a standard IOL (rare), and
- Post-refractive cases
- 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.