Supplemental testing isn’t considered routine.

Your patient may need services beyond those included in the routine exam. Please follow the requirements below when providing individually billable diagnostic and treatment services that aren’t included in the routine eye exam. Please ensure that the following conditions are met:

• Procedure is associated with a medical eye-related condition and is visually, developmentally, or medically necessary for your patient.
• A CPT code has been established for the procedure.
• Procedure is covered by your patient’s plan (see the Essential Medical Eye Care or Diabetic Eyecare Programs sections for a complete list of covered services).

Requirements for the Interpretation and Report of Diagnostic Procedures

Some procedures require an Interpretation and Report. This report is a major part of the procedure which is being reimbursed and should be a separately identifiable document. Include the following information in your report write-up:

• Clinical Findings (pertinent findings of the procedure) – What did you do? What did you find? Was the procedure reliable?
• Comparative Data (change in condition) – If prior procedures have been performed and a comparison is possible, has the patient’s condition gotten better, worse, or stayed the same?
• Clinical Management – Document what affect the test or procedure will have on your clinical management of the patient. For example, will you adjust medications, recommend surgery, or suggest further diagnostic testing?