2011 Medicare National Unadjusted Based Rates (non-facility)

Published December 28, 2010

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*These codes may be billed with a modifier if the clinical circumstances are justified. See item 2 below.
(1) Bilateral means the procedure is expected to be done on both eyes and the payment amount accounts for both eyes. Unilateral means the procedure is for a single eye; if both eyes are scanned, billing/payment would be twice the rate. Unilateral OR Bilateral indicates that the payment amount is the same regardless if one or both eyes are scanned.
(2) The National Correct Coding Initiative (NCCI) was developed by CMS and restricts billing certain codes together for the same patient on the same date of service. In some cases, certain NCCI edit code pairs may still be billed together with the use of a modifier, but only if the clinical circumstances are justified.
The information herein was generated by Quorum Consulting, San Francisco, CA and is not intended as a replacement of Medicare regulations or implementing guidelines. Rules may vary by state; please check with your local Medicare contractor. Responsibility for compliance with all Medicare rules and regulations rests solely with the performing provider.

The information herein was generated by Quorum Consulting, San Francisco, CA and is not intended as a replacement of Medicare regulations or implementing guidelines. Rules may vary by state; please check with your local Medicare contractor. Responsibility for compliance with all Medicare rules and regulations rests solely with the performing provider.