Forum - Questions & Answers

Nov 1st, 2017 - MM

Use of Ophthalmology CPT Codes

Does anyone know if Medicare allows providers other than those enrolled as Medicare providers as ophthalmologists and optometrists to use the CPT Medicine/Ophthalmology CPT codes for billing claims?



Nov 1st, 2017 - ChrisW   256  1 

re: Use of Ophthalmology CPT Codes

All healthcare providers, payers, and facilities use CPT® codes. There are certain codes that can only be billed by certain specialists. And each code has its own rule on how it can be used. A provider does not need to be enrolled in Medicare to report and get paid when billing CPT codes. Now, whether or not they will be reimbursed is another issue, I would suggest to you to read guidelines, LCD’s and articles pertaining to the codes in question. Even if a provider is not a Medicare provider there are a lot of payers that follow Medicare’s guidelines. If you are asking due to a matter of licensure, it will depend on the scope of practice under the license and the payer.

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