A Proposed Medicare Policy Would Tie Our Hands in the Fight Against Glaucoma

Chuck Williamson Jr

Glaucoma Today

As an ophthalmic practice administrator, I see every day what it takes to deliver the interventional glaucoma care necessary to preserve sight. It is not a simple cookie-cutter approach. A proposed Medicare policy would make it harder still, replacing physician judgment with a rigid, one-size-fits-all sequence that ignores how differently this disease behaves from patient to patient. What the LCDs Would Restrict Five Medicare Administrative Contractors (MACs) have similar Local Coverage Determinations (LCDs) in the proposal stage and available for comment through July 4. At issue is coverage of the intracameral travoprost implant (iDose TR, Glaukos). If the LCDs become finalized, Medicare would not cover the procedural pharmaceutical unless patients first fail both a trial of selective laser trabeculoplasty (SLT) and two topical medications. The LCD would also bar physicians from placing the implant during a MIGS procedure, whether that MIGS procedure is performed alone or in combination with cataract surgery. If finalized, the LCDs would take decision-making out of the hands of physicians and replace individualized judgment with a fixed treatment sequence applied to every patient. One Treatment Pathway Does Not Fit Every Patient Glaucoma is a heterogeneous disease. It presents and progresses differently in each patient, and physicians need a full range of options to treat each case individually.

The Intersection of Dry Eye and Allergies

Jackie Garlich, OD, FAAO; Jessilin Quint, OD, FAAO; and Mila Ioussifova, OD, CNS, FAAO, FOWNS

Eyetube

Co-hosts Jackie Garlich, OD, FAAO, and Jessilin Quint, OD, FAAO, invite Mila Ioussifova, OD, CNS, FAAO, FOWNS, back on the To the Point podcast to talk about in-office allergy testing. Dr. Ioussifova has built her dry eye and ocular allergy treatment armamentarium over the course of 13 years in practice. She notes that combined, dry eye and ocular allergy can be part of a vicious cycle if the underlying dysregulated immune system isn’t addressed—this is where immunotherapy comes in. Dr. Ioussifova covers her in-office pretesting protocol and the billing and reimbursement behind it.

Using Category III Codes

Five tips to help improve accuracy, payment, and compliance.

Matthew Baugh, MHA, COT, OCS, OCSR

Retina Today

Accurate coding for emerging retinal technologies requires more than familiarity with the standard American Medical Association (AMA) Current Procedural Terminology (CPT) Category I and Healthcare Common Procedure Coding System (HCPCS) codes; it also requires understanding CPT Category III codes. These temporary tracking codes, or “T” codes, are increasingly common in retina as innovation accelerates, yet they remain a frequent source of confusion, denials, and compliance risk. CPT Category III codes consist of four numeric characters followed by the letter “T.” Although they are valid CPT codes, they do not have assigned relative value units (RVUs) or national Medicare payment rates. As a result, coverage and carrier pricing for reimbursement are determined by the Medicare Administrative Contractor (MAC) or the individual payer. The following five practical tips outline how retina practices can use CPT Category III codes correctly to improve payer outcomes and position emerging services for future CPT Category I promotion. TIP NO. 1: DON’T DEFAULT TO PATIENT PAY A common misconception is that Category III codes are inherently noncovered and should automatically be billed to the patient. However, Category III status does not always mean investigational or noncovered. Rather, when a procedure is best described with a Category III code, it should be billed as such on the claim. Coverage decisions are based on medical necessity and payer policy—not the code category alone.