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03/09/2017

A-Scan Billing Update

A-Scan/ Ophthalmic Biometry by Partial Coherence Interferometry - Update

By Joy Newby

The AAO’s efforts pay big dividends for ophthalmologists performing cataract extraction procedures.

The Centers for Medicare and Medicaid Services (CMS) recently released the changes to the Medicare Physician Fee Schedule Data Base (MPFSDB) effective with dates of service on or after April 3, 2017. The update resolves the problems billing the professional component for the 2nd eye a-scan/OCB.

Since January 1, 2017, Medicare Administrative Contractors have been denying payment for the 2nd eye professional component. In changing the bilateral indicator from “2” to “3” for 76519-26 and 92136-26, CMS restores payment for unilateral interpretation and report.

Claims for bilateral 76519-26 and 92136-26 for the 2nd eye will continue to deny/reject until April 3, 2017. In the interim, ophthalmologists have options:

  • Continue billing the 2nd eye which will result in a denial/rejection - On April 3, 2017 if the claim for 76519-26 or 92136-26
  • denied with remark code MA01 - request a reopening from CGS for all denied claims
  • rejected with remark code MA130 - send a new claim CGS for each rejected claim
  • Hold claims for the 2nd eye until April 3, 2017 and send the held claims to CGS

Physicians do not have to complete a reopening request for each denied claim. Create a spreadsheet with the following columns:

  • Beneficiary’s first and last names
  • Beneficiary address
  • Beneficiary’s Medicare number
  • Beneficiary date of birth
  • Beneficiary telephone number
  • Internal control number (ICN) for denied 76519-26 or 92136-26
  • Date of service
  • Procedure code with modifier

***Be sure to include the name, address, and NPI for the practice in the spreadsheet header.

Complete all fields on the Medicare Part B Reopenings Adjustment Request Form. For the above fields, insert “see spreadsheet.” The form is available on the CGS website at http://www.cgsmedicare.com/forms/reopening_form.pdf

Enter your reason for requesting the reopening in the “Other” line in Reason for Request. No specific language is required, simply state the reopening request for the claims identified on the spreadsheet is due to a change from a bilateral to a unilateral service per MLN Matters article MM9977.