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Ophthalmology Management

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Consolidated Appropriations Act mitigates Medicare cuts

By: Suzanne L. Corcoran, COE
Ophthalmology Management February 1, 2021 Vol 25, Issue February 2021 Page(s): 12, 60

New legislation changes ophthalmology’s proposed 6% cut to a 1% increase.

By now, everyone has heard that Congress passed and President Trump signed the Consolidated Appropriations Act of 2021. Along with extending COVID relief, it addresses surprise out-of-network medical billing restrictions and mitigates cuts to the Medicare Physician Fee Schedule in 2021 by $3 billion on an $800 billion spend (3.75%).

According to CMS, this legislation changes the proposed 6% pay cut for ophthalmology to a 1% increase — a big improvement. Optometry will see a similar improvement. Looking a little deeper, some codes increase while others decrease on a year-over-year basis. See the Tables for examples.

These Medicare payment changes are welcome. The substantial increases for some codes, especially established patient E/M visits, offset the reductions and reach a favorable outcome. OM

Table 1. Ophthalmic surgical procedures — in facility
Code Description 2020 allow1 Initial 2021 allow2 Percent change from 2020 Amended 2021 allow3 Percent change from 2020
15823 Blepharoplasty $560.83 $518.54 -7.5% $558.29 -0.5%
66982 Complex Cat w/ IOL $765.10 $695.81 -9.1% $750.90 -1.9%
66984 Cataract w/ IOL $557.58 $508.17 -8.9% $548.17 -1.7%
Table 2. Ophthalmic surgical procedures — in office
Code Description 2020 allow1 Initial 2021 allow2 Percent change from 2020 Amended 2021 allow3 Percent change from 2020
15823 Blepharoplasty $629.40 $588.54 -6.5% $631.91 0.4%
65855 Laser Trabeculoplasty $252.27 $232.69 -7.8% $250.53 -0.7%
66761 Laser Iridotomy/Iridectomy $306.40 $285.84 -6.7% $306.36 0.0%
67028 Intravitreal Injection $103.22 $106.95 3.6% $115.15 11.6%
68761 Punctal Occlusion Plug $151.58 $141.95 -6.4% $152.48 0.6%
Table 3. Exams and tests
Code Description 2020 allow1 Initial 2021 allow2 Percent change from 2020 Amended 2021 allow3 Percent change from 2020
92004 NP Comprehensive Eye $152.66 $141.95 -7.0% $152.48 -0.1%
92012 EP Intermediate Eye $89.86 $84.59 -5.9% $91.07 1.3%
92014 EP Comprehensive Eye $128.12 $119.59 -6.7% $128.41 0.2%
99202 NP E/M Level 2 $77.23 $69.03 -10.6% $73.97 -4.2%
99203 NP E/M Level 3 $109.35 $106.30 -2.8% $113.75 4.0%
99204 NP E/M Level 4 $167.09 $159.77 -4.4% $169.93 1.7%
99205 NP E/M Level 5 $211.12 $210.98 -0.1% $224.36 6.3%
99212 EP E/M Level 2 $46.19 $54.12 17.2% $56.88 23.1%
99213 EP E/M Level 3 $76.15 $86.85 14.1% $92.47 21.4%
99214 EP E/M Level 4 $110.43 $123.48 11.8% $131.20 18.8%
99215 EP E/M Level 5 $148.33 $172.74 16.5% $183.19 23.5%
92083 Visual Field $64.24 $59.96 -6.7% $64.20 -0.1%
92133 SCODI Optic Nerve $37.89 $35.00 -7.6% $37.68 -0.6%
92134 SCODI Retina $41.50 $38.57 -7.1% $41.52 0.0%

Suzanne L. Corcoran is vice president of Corcoran Consulting Group.

References

  1. CY 2020 MPFS allowed amount.
  2. CY 2021 MPFS allowed amount as published in the December 28, 2020, Federal Register, 1734-F final rule.
  3. CY 2021 MPFS allowed amount as published January 5, 2021, incorporating changes based on the Consolidated Appropriations Act 2021 (Omnibus COVID Relief).

QUICK NOTES

Alcon launched the AcrySof IQ Vivity IOL, the first non-diffractive extended depth of focus IOL available in the United States. The Vivity IOL uses Alcon’s proprietary non-diffractive X-WAVE technology, which stretches and shifts light without splitting it.

Haag-Streit announced the Lenstar Myopia, consisting of the Lenstar 9000 optical biometer and the corresponding EyeSuite software EyeSuite Myopia. EyeSuite Myopia uses the latest axial length growth curves developed at the Erasmus University Medical Center in Rotterdam, the Netherlands.

Hi-Health launched its new Eye Care Division, with products under Hi-Health’s Vista brand. The initial product offering includes artificial tears and tea tree oil-based lid cleansing products.

Glaukos announced results from an interim analysis of its Phase 2b clinical trial for iDose TR, a sustained-release travoprost implant. Results included average IOP reductions from baseline of 29% and 28% in the fast- and slow-release iDose TR arms vs 30% in the timolol control arm. Glaukos also shared data from a 12-month U.S. Investigational Device Exemption pivotal trial that showed its iStent infinite Trabecular Micro-Bypass System achieved a substantial reduction in mean diurnal IOP in patients with open-angle glaucoma uncontrolled by prior therapy.

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