Glaucoma Screening

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:

Resources:

• Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 280.1 - Glaucoma Screening (PDF, 1.33 MB) 
• MLN Medicare Preventive Services Educational Tool