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CODING & BILLING
2013 Medicare National
Payment Rates for Glaucoma Surgery
Procedure
Aqueous shunt
Trabeculectomy
Canaloplasty
Hospital Outpatient Rate
$2,977.93
$1,676.62
$2,977.93
ASC Rate
$1,671.00
$940.80
$1,671.00
• 0192T. Report 0192T Insertion of anterior segment aqueous
drainage device, without extraocular reservoir; external approach
for a device placed via external approach such as the Aquaflow
Collagen Glaucoma Drainage Device and the Ex-Press Glaucoma
Filtration Device. Medicare HCPCS code C1783 Ocular implant,
aqueous drainage assist device is reported for the device. As is the
case with L8612, C1783 is considered packaged into the main procedure under the OPPS and ASC payment systems and is not separately reimbursed by Medicare.
Diagnosis codes from the open angle glaucoma series (365.10365.15) currently demonstrate medical necessity for code 0192T,
according to CMS. Keep up to date with your local Medicare contractor's coverage determinations and check your commercial payer contracts for current coverage requirements. Also encourage your surgeons to make sure they adequately document the indications for the
procedure(s).
Under OPPS, the codes for all glaucoma procedures considered
above belong to APC 0673, which has a Medicare national payment rate
of $2,977.93 for 2013. Because the above-mentioned devices have an N
M A R C H 2013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
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