Z13.5 — Encounter for screening for eye and ear disorders
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
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.
- Fuchs' endothelial dystrophy
12 Active Policies
AMBETTER-CG-Eye-Disorders-2025.1 — Concert Genetic Testing: Eye Disorders
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
AETNA-CPB-0181 — Evoked Potential Studies
AETNA-CPB-0344 — Optic Nerve and Retinal Imaging Methods
AETNA-CPB-0563 — Retinopathy Telescreening Systems
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