Billing and Coding: Panretinal (Scatter) Laser Photocoagulation

Medicare covers panretinal (scatter) laser photocoagulation (PRP) when medically necessary and supported by the LCD and detailed medical record documentation. Claims must include a valid ICD-10-CM diagnosis, required referring/ordering physician name and NPI when applicable, and correct modifiers (LT/RT/-50); payment is generally allowed only once during the initial procedure's global period and subsequent related sessions are included in that allowance, while certain CPT codes (67208, 67210, 67227) require distinct indications to be separately payable.

"Panretinal (scatter) laser photocoagulation (PRP) is covered when medically necessary and supported by the Local Coverage Determination (LCD) and the patient's medical record."

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