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Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
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Related Articles
- Medicare Preventive Services Resource Guide
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Glaucoma Screening
Glaucoma is a group of eye diseases in which damage to the optic nerve results in loss of eyesight. Medicare beneficiaries over the age of 60 have an increased risk of developing glaucoma. CMS has determined that the evidence is adequate to conclude that a screening for glaucoma is reasonable and necessary for the early detection or prevention of an illness or disability and is appropriate for certain Medicare eligible individuals.
Coverage Criteria and Frequency Limits
Covered once every 12 months (11 full months must pass before next screening) for beneficiary’s who fall into at least one of the following high risk categories:
- Individuals with diabetes mellitus
- Individuals with a family history of glaucoma
- Black or African-Americans aged 50 and older
- Hispanics or Latinos aged 65 and older
Risk Factors
- Age
- Race
- Family history
- Medical history
Screening Components Include:
- Dilated eye examination with an intraocular pressure (IOP) measurement
- Direct ophthalmoscopy examination or a slit-lamp bio microscopic examination
HCPCS/CPT Coding
- G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
- G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
Diagnosis Coding
- Z13.5: Encounter for screening for eye and ear disorders
Documentation
- Beneficiary is one of the high-risk groups
- Appropriate screening was performed
- Legible signature of person performing service with credentials
Who Can Perform?
- Must be furnished by or under direct supervision of optometrist or ophthalmologist
Cost Sharing
- Copayment/coinsurance applies
- Deductible applies
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers:
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denial Reasons
- Benefit maximum for this time period has been reached
- Services not covered unless patient is classified as at high risk
Noncovered Routine Vision Services
- Eyeglasses
- Eye exams
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 70.1.1
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 30.4
- MLN® Fact Sheet: Medicare Vision Services
- National Correct Coding Initiative
- Ophthalmology/Optometry Billing Guide
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 9/27/2024