Ophthalmology is fortunate to have many tests available to help care for patients. A new test is heterochromatic flicker photometry (HFP) to aid in early diagnosis of AMD.

Q. What is HFP, and how does it work?

A. HFP is a diagnostic test to measure macular pigment optical density (MPOD).¹ The pigments zeaxanthin, lutein and the metabolite meso-zeaxanthin shield the retina from damage related to short wavelength, high-energy, visible, blue light (400-495 nm). Such damage contributes to the development of AMD.² Measurement of MPOD over time can assess whether dietary changes, antioxidant supplementation, or both, may diminish the harmful effect of blue light.³ The National Eye Institute has predicted a 50% increase of AMD in the United States. between 2004 and 2020.⁴

Measurement of MPOD is typically performed in an ophthalmologist’s or optometrist’s office. It is done in a quiet, darkened room on one eye, while the other is occluded. The patient views a small circular stimulus that alternates between a blue wavelength (460 nm), which is absorbed, and a green wavelength (540 nm) that is not absorbed by the macular pigment. The patient sees a flicker at the moment when the macular pigment is saturated by the absorbed blue light and presses a response button on the device. An MPOD measurement is generated; the physician interprets it and explains the results to the patient.

In some cases where the patient has pre-existing pathology, a peripheral test is also performed.

Q. What CPT code do we use to report measurement of MPOD?

A. Report CPT code 0506T: Macular pigment optical density measurement by hetero-chromatic flicker photometry, unilateral or bilateral, with interpretation and report. It is effective for dates of service on or after July 1, 2018.

There is no Medicare-allowed amount. As with all Category III codes, it was established to allow for data collection and analysis; no RVUs are assigned to it within the Medicare Physician Fee Schedule. We expect payers will designate this service as “experimental or investigational” and “not medically necessary,” and deny coverage.

Q. What about repeat HFP testing?

A. Testing measures MPOD; any changes indicate improvement or a decline in the amount of pigmentary shielding to short wavelength, high-energy, visible blue light. It is postulated that periodic testing in at-risk patients exposed to high oxidative stress, such as smokers, alcoholics and those with low dietary intake of carotenoid-rich foods, may be useful to evaluate and manage early stage AMD.

Q. What does “interpretation and report” require for HFP?

A. A brief notation such as “abnormal” does not suffice. The medical record should include:

• Order for the test with medical rationale.
• Date of the test.
• Reliability of the test.
• Test findings (i.e., MPOD measurement).
• Comparison with prior tests (if applicable).
• A diagnosis (if possible).
• The impact on treatment and prognosis (i.e., treatment with diet rich in antioxidants, antioxidant supplements or both).
• Physician signature and date.

Q. How do I document patient acknowledgement of financial responsibility?

A. Patients are given the opportunity to choose whether to have the test. After the benefits have been explained, the patient is advised of the extra charge and asked to assume financial responsibility. A financial waiver can take several forms, depending on insurance.

An Advance Beneficiary Notice of Noncoverage (ABN) is required for services for which Part B Medicare coverage is ambiguous or doubtful and may be useful where a service is never covered. You may collect your fee from the patient at the time of service or wait for a Medicare denial. If both the patient and Medicare pay, promptly refund the patient or show why Medicare paid in error.

For Part C Medicare (Medicare Advantage), determination of benefits is required to identify beneficiary financial responsibility prior to performing noncovered services. MA Plans have their own waiver processes and are not permitted to use the Medicare ABN form.

For commercial insurance beneficiaries, a Notice of Exclusion from Health Plan Benefits, or NEHB, is an alternative to an ABN. OM

REFERENCES

1. Stringham JM, Hammond BR, Nolan JM, et al. The utility of using customized heterochromatic flicker photometry (cHFP) to measure macular pigment in patients with age-related macular degeneration. Exp Eye Res. 2008;87:445-453. https://www.ncbi.nlm.nih.gov/pubmed/18778703 . Accessed June 28, 2018.
2. The Age-Related Eye Disease Study 2 (AREDS2) Research Group. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression. AREDS2 Report No. 3. JAMAOphthalmol. 2014;132:142-149. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/1788227 . Accessed June 28, 2018.
3. Ma L, Liu R, Du JH, et al. Lutein, zeaxanthin and meso-zeaxanthin supplementation associates with macular pigment optical density. Nutrients. 2016; 8:E426. https://www.ncbi.nlm.nih.gov/pubmed/27420092 . Accessed June 28, 2018.
4. The Eye Diseases Prevalence Research Group. Prevalence of age-related macular degeneration in the United States. JAMA Ophthalmology. 2004;122:564-572. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/416232 . Accessed June 28, 2018.

Suzanne L. Corcoran is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com .