WELCH ALLYN SURESIGHT™ VISION SCREENER REIMBURSEMENT QUICK REFERENCE SHEET
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
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.
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.
For reference only. Information does not constitute a guarantee of coverage or payment.
PN 140359 Rev A |
June 2002 |
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