One of the less-well-known aspects of codes and coding is that CPT codes are actually released twice a year. Category I codes are what we know best, and those are released annually on January 1. Category III codes are released twice a year—on both January 1 and July 1. This July, there are two Category III codes (0506T and 0507T) affecting eye care that practitioners and practices should be aware of.
Q: What is code 0506T?
A: New category III code 0506T has the following code descriptor: “Macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report.” The code can’t be used for reimbursement, but it’s used for research. There is at least one new instrument just on the market that measures the macular pigment optical density in just this way. The macular pigments zeaxanthin, lutein, and the metabolite mesozeaxanthin in the retina shield it from damage related to short-wavelength, high-energy, visible blue light (400495 nm). Such damage contributes to the development of age-related macular degeneration. Measurement of MPOD over time can assess whether dietary changes and/or antioxidant supplementation may diminish the harmful effects. The National Eye Institute predicted a 50-percent increase in AMD in the U.S. population between 2004 and 2020.
Note that the code is used once whether one or both eyes are measured and requires an interpretation and report.
Q: What is heterochromic flicker photometry?
A: In the one device available now for MPOD measurement (others will likely be similar), the patient views a small circular stimulus that alternates between a blue wavelength (460 nm), and a green wavelength (540 nm), which are absorbed and not absorbed by the macular pigments, respectively. The patient sees a “flicker” when the macular pigment is saturated by the absorbed blue light and is instructed to press a response button at that moment. An MPOD measurement is then generated by the device.
Q: What is code 0507T for?
A: The code descriptor for 0507T is as follows: “Near-infrared dual imaging (i.e., simultaneous reflective and trans-illuminated light) of meibomian glands, unilateral or bilateral, with interpretation and report.” CPT also has a parenthetical note for this code, which states “For external ocular photography, use 92285. For tear film imaging, use 0330T.” Infrared imaging of the meibomian glands is currently available via a number of devices on the U.S. market.
As with the other July 1 code, this one is used one time whether one or both eyes are imaged and requires an interpretation and report.
Q: Are there specifics regarding when these new codes can be used for Medicare?
A: Yes. As mentioned above, both codes are for use as of July 1, 2018. Each of these codes has a “sunset” date of December 31, 2023. As a result, these can no longer be used as of January 1, 2024 unless they are extended, which isn’t common. All Category III codes end in the letter “T” to denote their temporary nature.
Q: What is the payment within Medicare?
A: New Category III codes generally do not have coverage at all. Individual Medicare Administrative Contractors (MACs) get to decide whether to cover them—and at what reimbursement; since that may take some time with a new code, a financial waiver of some sort (ABN for Part B, for example) is a good idea since these will likely both be patient-pay at first.
Q: Can I use another code that already has coverage instead of these so my patients don’t have to pay out-of-pocket?
A: No. New code 0507T already makes the case in the parenthetical note that 92285 (the most likely other code) is improper. Additionally, CPT has long noted that if there is a code of any sort that fits and is active, it must be used. Even an unlisted code such as 92499 (unlisted ophthalmological service or procedure) is not correct. CPT notes the following in the Overview to the Category III section of the book: “The following section contains a set of temporary codes for emerging technology, services, procedures and service paradigms. Category III codes allow data collection for these services/ procedures.” CPT also states: “Use of unlisted codes does not offer the opportunity for the collection of specific data. If a Category III code is available, this code must be reported instead of a Category I unlisted code.” REVIEW
Mr. Larson is a senior consultant at the Corcoran Consulting Group. Contact him at plarson@corcoranccg. com.
