Welch Allyn SureSight Vision Screener - Quick Reference Guide - Manual

WELCH ALLYN SURESIGHT™ VISION SCREENER REIMBURSEMENT QUICK REFERENCE SHEET
For reference only. Information does not constitute a guarantee of coverage or payment.
Private Insurance
Coverage Use of the SureSight in the physician office is usually covered by private payers
when medically necessary.
Coding Coding options for use of the SureSight vary by payer and by plan. There are
several coding options for use of the SureSight, including the following:
• 92015, Determination of refractive state
•
99173, Screening test of visual acuity, quantitative, bilateral
Payment Payment for use of the SureSight varies by payer, plan, and provider contract
and may be separately payable in the physician office setting.
Medicaid
Coverage Use of the SureSight in the physician office is usually covered by Medicaid
programs when medically necessary.
Coding Coding options for use of the SureSight vary by state and include:
•
92015, Determination of refractive state
• 99173, Screening test of visual acuity, quantitative, bilateral
•
Local or other codes, determined individually at the state level
Payment Medicaid payment for use of the SureSight varies by state, but typically falls
within the range of $5 to $20.
Other Considerations
Some payers may have specific requirements for using certain codes, including prior
authorization, restricted medical diagnoses, or specialty provider types. For example:
• CPT code 92015 is categorized as a “Special Ophthalmology Service” by CPT 2002. The
CPT states that “the listing of a service or procedure and its code number in a specific
section of this book does not restrict its use to a specific specialty group.” However,
some payers may impose restrictions based on physician specialty.
•
CPT code 99173 may be considered a bundled service by certain payers and determined
to be part of the office visit or preventive medicine procedure.
Be sure to confirm the requirements and specific coverage guidelines of the payer you are
billing before submitting claims by reviewing contracts, consulting the
Physicians’ Current
Procedural Terminology, Fourth Edition (CPT-4) or The Federal Register , or contacting
provider services.
If you have questions about reimbursement for SureSight, please call toll-free:
Welch Allyn Reimbursement Support Line
1-800-946-1212
Monday-Friday, 9:00AM to 5:00PM Eastern Time
PN 140359 Rev A
June 2002
For assistance in determining payer specific
coverage, coding or payment levels for the SureSight Vision Screener,
call the Welch Allyn Reimbursement Support Line.
1-800-946-1212.