Medicare coverage of glaucoma screenings was implemented with the Benefits Improvement and Protection Act of 2000 (BIPA).
A glaucoma screening is defined to include:
- A dilated eye examination with an intraocular pressure (IOP) measurement
- A direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination
Medicare covers glaucoma screening for the following persons considered to be at high risk for developing this disease:
- Individuals with diabetes mellitus
- Individuals with a family history of glaucoma
- African-Americans or age 50 and over
- Hispanics-Americans 65 and older
Glaucoma screening frequency limitations and payment information:
- Medicare pays for this service annually (i.e., at least 11 full months must have passed following the month in which the last Medicare-covered glaucoma screening examination was performed)
- Services rendered more frequently than allowed under this screening benefit may require that the beneficiary be given an Advance Beneficiary Notice (ABN)
- The beneficiary will pay 20 percent as the co-payment or coinsurance after meeting the yearly Part B deductible
Medical record documentation requirements:
- Medical record documentation to support that the beneficiary is a member of one of the high risk group, as defined above
- Documentation must support one of the screening defined:
- A dilated eye examination with IOP measurement and direct ophthalmoscopic examination, or a slit-lamp biomicroscopic examination
Procedure and Diagnosis Code Information:
| HCPCS Codes | HCPCS Code Descriptors | Diagnosis Code |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
V80.1
(Special Screening for Neurological, Eye, and Ear Disease, Glaucoma) |
| G0118 |
Glaucoma screening for high risk patients furnished under the direct supervision of optometrist or ophthalmologist |
V80.1
(Special Screening for Neurological, Eye, and Ear Disease, Glaucoma) |
References