Turning Problems into Profits

Medicare Telehealth Options to Address COVID-19 Emergency

As many optometrists are aware, the CDC and AOA have both recommended all routine eye exams be rescheduled because of the coronavirus outbreak.  Medicare has also issued three new coding options to help address the challenges COVID-19 is presenting to optometrists.

First, optometrists are now allowed a VIRTUAL CHECK-IN with patients for follow-up visits.  If the physician has not seen the patient within the last seven days and will not see the patient again for 24 hours, they can use this option.  Virtual check-ins are 5-10 minute visits over the phone or using captured video or images that are billed with G codes.  Physicians can’t bill this option if they decide to have the patient come in within 24 hours.  G2012 is used for telephone follow-up visits and G2010 is for captured video or images. The reimbursements for these G codes are generally low, around $15.

The second option, called ON-LINE DIGITAL EVALUATION, is communication with patients through the physician’s online portal. If the patient initiates the portal contact, the physician can bill for the cumulative time they spend communicating with the patient over a seven day period, provided they don’t see the patient for a medical visit within 24 hours. Previous HIPAA requirements or the capabilities to store these patient communications have been waived during the COVID-19 emergency. The billing codes are based upon total time spent answering the patient through the portal: 99421 is for 5-10 minutes and reimburses around $15.52; 99422 for 11-20 minutes, $31.04; and 99423 for 21 or more minutes, $50.16.

Finally, Medicare’s new COVID-19 guidelines allow for TELEHEALTH SERVICES. These are office visits conducted over video applications such as Facetime or Skype and are billed with the 99-series evaluation and management codes, such as 99212 or 99213.  The 92-series eye exam codes do not apply.  Unlike previous telehealth guidelines, this option is no longer restricted to remote or rural areas, the patient can be at home, and providers do not have to use a HIPAA compliant software, only any real-time audio and video for live, interactive telecommunication between the provider and patient.  Billing for telehealth exams requires some software setup for required modifiers and place of service, so if any of OBS doctors decide to utilize this option, please notify your coordinator or Branda so that we can ensure the claims have the proper coding.

So far these three billing options have only been approved by Medicare, but because Medicare sets the gold standard in billing, other commercial payers often follow. Some commercial carriers may already have other remote billing options in place for telephone evaluations. We can only advise providers to check with their local commercial insurance carriers to see what options they may have to continue to provide medical eye care to patients throughout this emergency.

Here are links to the AOA webinar held on March 17 that covers Medicare’s changes in more detail:   AOA Recorded Webinar     Link to PowerPoint


Spectera is currently issuing new contracts which require all clinics to use an Essilor lab for glasses, including Vision Source providers who have always had the autonomy to choose their own lab. If you are a Spectera provider, this means you will no longer have the option to operate as your own lab UNLESS you live in a state that has passed legislation allowing optometrists and patients the freedom of choice in lab selection. Doctors who practice in a “Lab of Choice” state (such as Alabama, Arkansas, Florida, Georgia, Kansas, Maine, Missouri, New Jersey, Oregon, Texas, Vermont, Virginia, and West Virginia) cannot be forced to use a designated lab IF THEY DO NOT SIGN THE NEW LAB CONTRACT and negotiate a new agreement. So if you live in one of the above states, please do not sign the new Spectera contract until you talk to Branda. If you are a Vision Source provider, you also need to talk to Branda. Even if your practice is in a state without legislative protection and you’re forced to use a designated lab, there are still things that need to change in the way your opticians operate and how we bill for you. And finally, if you are uncertain what the new Spectera contract means for your practice or you just have questions, please feel free to call 877-727-3695. Ask our receptionist Misty to schedule an appointment time so you and Branda can discuss your options.

2020 Route Slip

We recently updated our ICD-10 route slip to reflect the new 2020 changes in ophthalmoscopy and cataract surgery codes (see below). The route slip is free for anyone to download who wants a paper backup to use at their office for those times when their software may go down.  If you are an OBS client, and would like a copy of the route slip to customize for your office, call Mary at 877.727.3695 and she can send you an editable version in Excel.

Click here to download:  Revised 2020 Route Slip

DISCLAIMER:  Please be aware that this is an abridged document not intended to replace a standardized coding manual with complete references and annotations.   Optometric Billing Solutions has made a good faith effort to review the contents for accuracy, but it is up to doctors and office to review all codes for completeness and correctness.  However, if you do find an error we missed, please email Mary at mary@obsTeam.com and she’ll be happy to review and correct the error and get an updated version posted!

Important Coding Changes for 2020

There have been some important coding changes for 2020.


First of all, CPT codes 92225 and 92226 for extended ophthalmoscopy were deleted as of January 1, 2020. We now have two new codes based upon what area of the retina was examined and documented. (Ophthalmoscopy is no longer reported as initial and subsequent testing.) Use 92201 for examination of the retinal periphery or 92202 for the optic nerve and macula. Another important change for extended ophthalmoscopy is billing. These codes are now considered bilateral and are billed on one line with one reimbursement. (The old codes were billed per eye.) This, of course, is going to impact our doctors’ reimbursements.


Additionally, starting January 1, 2020, two new codes were added for cataract surgeries: 66987 and 66988. These codes are used when two surgeries are done together to treat both cataracts and glaucoma. The surgeon first performs traditional cataract surgery with IOL insertion and then performs a laser surgery called ECP (Endoscopic Cyclophotocoagulation) for patients with uncontrolled glaucoma to reduce their intraocular pressures. CPT 66987 is for complex cataract surgery with ECP, and CPT 66988 is for basic cataract surgery with ECP. Also, the description for existing cataract surgery codes 66982 and 66984 have now been revised to read “without endoscopic cyclophotocoagulation.” We may start to see some of these new cataract surgery codes as we bill co-manages in the coming months.

Late EyeMed EOBs

6/18/19  EyeMed appears to be dropping remits this week from 6/4/19 that have not previously shown up on their website. Therefore, billers need to check their disbursement history to see if they have EOBs that weren’t there two weeks ago. Also, we’re also finding that some of these back-dated remits have no lab charges listed, so the checks don’t balance. However, if you look up the remit on EyeMed’s website, the claim is listed correctly so you can post and balance. Oh, the joys of billing!


Davis Vision has teamed up with InstaMed to offer EFT payments to providers. For more information, log in to your Davis provider portal.  There is an easy sign up form for providers to begin to receive direct deposits into their bank accounts along with electronic remittances.

Aspex Eyewear Back in Network with VSP

VSP and Aspex Eyewear announced today that they have settled their legal disputes and that Aspex is rejoining the VSP network as an in-network frame provider.    As part of the agreement, Aspex agreed to pay a financial settlement to VSP and settle prior lawsuits.  The agreement between the two companies means that VSP patients may now purchaes Aspex frames under their VSP vision plans.

VSP Checks Shorted by Altair Glitch

ATTENTION VSP CLINICS WITH ALTAIR TAKE-BACKS: If your VSP check usually has take-backs for Altair frames, then the 2/15 check that dropped today may be significantly short because of an Altair-Eyefinity glitch. Altair take-backs were either doubled or totally zeroed out the checks with an additional chargeback line titled “Eyefinity Services.” We called VSP, Eyefinity, and Altair this morning as soon as we discovered the problem. The Altair official said the error was totally on their end. They discovered it late last night and started going through accounts. They are currently in the process of issuing paper checks that will come through the mail. They are prioritizing by the amount of the take-back error, working on the largest take-backs first for accounts that were shorted over $1,000. OBS did an audit for all our clinics’ checks and has already contacted Eyefinity on behalf of those clinics that the Altair error impacted. A paper check should be mailed to you by next week. If you do not have payment for your Altair frames taken out of your VSP checks, then this glitch did not affected your VSP payment.

Is it Time to Review your Fees?

The beginning of the year is a great time for clinics to review their fee schedule to ensure they’re getting reimbursed fairly from insurance payers.  Every practice needs to periodically review their fees to make sure they’re charging enough. One of the best ways you know it’s time to increase fees is if you’re not taking a write-off when we post your insurance payments. If insurance companies are allowing everything you charge, it means they’d actually pay you more if your fees were higher! For practices who need help deciding where to set their fees, Medicare is a good place to start. All Medicare jurisdictions publish their fee schedules, and the information is easy to find with a simple Google search. Commercial medical payers usually won’t give you a copy of their fee schedules, but their allowables are generally higher than Medicare’s. Many practices set their fees 25-30% above Medicare allowables. If you’re an OBS client, don’t hesitate to ask us to review your fee schedule with you! With clinics in 41 states, we are very knowledgeable about what insurances allowables are for your area, and we can do an analysis and let you know where you may be undercharging based on your insurance payments.

Are you exempt for MIPS?

CMS has a handy tool for doctors to determine if they are exempt from MIPS participation in 2018 because they saw less than 200 Medicare patients or billed less than $90,000 in Medicare fees.  Go to https://qpp.cms.Gov/participation-lookup.

CAUTION: It’s the number zero, not the letter O!

One of our billers was so excited because she filed her first claims with the new 11-character Medicare IDs, but her excitement soon turned to disappointment when 14 of the 16 claims rejected.   It took a little research and a few calls to Medicare to discover the problem:  the office had entered the ID numbers with the letter O instead of the number zero!

In order to avoid confusion over letter and number look-alikes, the new IDs will NOT have the letters O, I, B, L, S, or Z.    So when you see that round character in the ID, type in the number zero and not the letter O! (Or 1, 8, 5, and 2, instead of I, B, S, or Z!)  Being careful to enter the correct ID will save us all of lot of time-consuming rejections!

Please remind your front desk staff to be asking patients if they have received their new Medicare cards yet.  Scan copies of the new cards and update the Medicare numbers in your software.  Medicare will allow us to file under both IDs through next year, but you’ll want to start updating your records now.   Also, when you type in the numbers, please enter the IDs without dashes even though dashes appear on the card.

New Medicare Cards with New Numbers

April 1, 2018–Important Medicare Changes Starting Now!

Beginning today and continuing throughout the next year, Medicare patients will be receiving new cards with new ID numbers.  In an effort to protect beneficiaries from identity theft, CMS is switching from social security numbers to 11-character IDs using both numbers and upper case letters.  Numbers will be generated randomly for each patient, and characters will have no assigned meaning.

Starting today, please make sure your front desk staff asks to see all cards from your senior patients.  If patients have already received their new card, take a copy and enter the new ID into your software, without the dashes.  If patients don’t have a new card yet, tell them that sometime during the next year they will be receiving a new card with a new number and ask them to bring  the new card to all appointments.  All Medicare patients will have new cards and numbers by April 16, 2019.

Railroad Medicare patients will also be receiving new cards. The new Railroad IDs don’t appear to be any different than traditional Medicare numbers, which could create filing issues since Railroad claims have to be sent to a different address.  Therefore, your front desk staff should be especially diligent to look for the Railroad logo on the top of the card or the “Railroad Retirement Board” notice on the bottom banner so they can enter these cards into your system as Railroad Medicare and not under traditional Medicare.

CMS knows that this will be a big change for both beneficiaries and providers alike,  Therefore, they will allow claims to be filed under either the old ID or the new ID until December 31, 2019 to give providers enough time to get their systems updated with the new numbers.  However, after this transition period is over, all claims without the new ID numbers will deny, so it’s important to start updating your software now!  Starting in June, CMS will also be providing a new lookup tool to assist offices in getting the most current numbers for their patients–but the easiest way is to get into the habit of asking patients for their new cards now!