The procedures listed below are used to treat conditions involving the eye by various means, e.g., diathermy, cryotherapy, laser, etc., whether performed in one or more stages or sessions. The code appropriate to the method of treatment should be reported and reimbursed only once regardless of the number of sessions required to successfully complete the procedure.

The procedure codes listed on this bulletin are all considered staged procedures if the same exact code is reported by the same provider within the postoperative period. In addition, codes 67141-67229 are considered staged procedures when reported within the postoperative period of procedure codes 67101-67113, 67141-67208, 67218-67229. In this instance, no additional payment should be made beyond that already allowed for the initial procedure. Services performed on the other eye are not considered part of the original surgery and are eligible for payment.

NOTE:

Separate payment can be made for the treatment of new retinal conditions in a different segment of the same eye. Different segments can be determined by quadrants i.e., upper outer, upper inner, lower outer, lower inner. It will be necessary for the provider to submit medical records and/or additional documentation to determine coverage in this situation.

This medical policy may not apply to FEP.  Medical policy is not an authorization, certification, explanation of benefits or a contract.  Benefits are determined by the Federal Employee Program.