G0118 — Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.17
Facility
$40.42
Non-Facility
$40.42
Documentation Required
- Medical records must document that the beneficiary is a member of a high-risk group to support coverage.
- Medical records must document the screening components performed: dilated eye exam with IOP measurement and either direct ophthalmoscopy or slit-lamp biomicroscopic examination.
- Claims must include the appropriate HCPCS code (G0117 or G0118) and may be submitted with diagnosis code Z13.5 (Encounter for Screening for Eye and Ear Disorders).
- If services are furnished more frequently than allowed, documentation that a signed ABN was issued to the beneficiary must be retained in the medical record.
Key Coverage Criteria
- Medicare covers glaucoma screening for beneficiaries with diabetes mellitus.
- Medicare covers glaucoma screening for beneficiaries with a family history of glaucoma.
- Medicare covers glaucoma screening for African American beneficiaries age >=50 years.
- Medicare covers glaucoma screening for Hispanic American beneficiaries age >=65 years.
- A covered glaucoma screening must include a dilated eye examination with intraocular pressure (IOP) measurement and either a direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.
1 Active Policy
A53495 — Glaucoma Screening
Related Codes
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