Speaker addresses billing of diagnostic system
NEW ORLEANS — A physician here discussed the precedence for billing at the ORA System Symposium, sponsored by WaveTec Vision.
There is no specific ruling by the Centers for Medicare and Medicaid Services regarding the ORA System, so physicians should follow similar precedence, Robert Fintelmann, MD, FACS, said.
Two key points to remember when billing are that refractions are not covered by Medicare and that practices should review the ruling for femtosecond lasers.
Imaging is approved for billing when used in conjunction with an advanced technology lens, subject to some important limitations, according to the presentation.
“If you stick with ORA being a refraction in the operating room, then you’re fine, as long as you combine ORA with something else that is used and has a similar precedence. Avoid using the ‘golden scalpel rule’ by telling the patient that, ‘I’m going to get a better lens selection.’ Lens selections are covered by Medicare, so you cannot bill the patient extra if you use it in a different way,” Fintelmann said.
He said that if a practice uses the system with an advanced technology lens, uses it specific to astigmatism correction and is part of the astigmatism correction fee, or uses a standard lens as a part of astigmatism management, then that gives the practice precedence for billing.
Disclosure: Fintelmann has no relevant financial disclosures.