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UT Medicaid Doesn’t Allow Optometrists to Bill Cornea Topography

on May 18th, 2011 | Filed under Optoblog

Utah Dept. of Health logoI tried billing corneal topography (92025) to Utah Medicaid as part of managing a patient’s keratoconus, and I was shocked to have it denied. The reason?

The procedure code is inconsistent with the provider type/specialty (taxonomy).

So I called Utah Medicaid, and confirmed that 92025 is the code for corneal topography, and they confirmed that optometrists are not allowed to be paid for corneal topography because only physicians and hospitals are allowed to bill this procedure code. I pressed that optometrists manage conditions like keratoconus with corneal topography and that their policy definitely needs to be changed. The UT medicaid worker said she would bring it up at their meeting, but that meeting isn’t until next week, and she had several other issues that weren’t address at the last meeting.

So, I think she was telling me that she couldn’t guarantee that anything regarding my issue would be addressed in the near future. Even if they do discuss it sometime this month, they might not change their mind.

THIS IS COMPLETELY RIDICULOUS!!!. Hospitals? Hospitals can bill for corneal topography? How often do they do that? Can we name even one hospital that even owns a corneal topographer? The only physicians who use corneal topographers are ophthalmologists, but if I were a pediatrician they would allow me to bill for it?

Attention Utah Medicaid Taxonomy-Procedure-Provider-Type Committee: I hereby declare that you should immediately allow optometrists, provider type 31, to bill and be reimbursed for computerized cornea topography, CPT code 92025. Blue Cross allows it. I am trained to perform and analyze this test in optometry school. I need it to manage conditions like keratoconus, irregular astigmatism, pterygium, pellucid marginal degeneration, and transplanted cornea. All of these conditions I see in my practice.

Until now, I am willing to grant that the taxonomy/provider-type thing is an oversight- a snafu with the computer database. Now that this error has come to light, the only reason I can think that Utah Medicaid would continue in this erroneous policy is that the committee members making that decision are a bunch of anti-optometrist bigots. I don’t want to think that, so please reverse your policy as quickly as possible and allow optometrists to bill corneal topography.

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1 Comment

One Response to “UT Medicaid Doesn’t Allow Optometrists to Bill Cornea Topography”

  1. Mike says:

    This is a great example of what your AOA / UOA membership can do for you. A few years ago there were MANY codes under our scope of practice that Utah Medicaid would not pay. We compiled a list of the codes, met with Medicaid and had the codes added as payable to OD’s. We must have missed topography. If I recall, it takes something like an act of congress to add a code to the system and with budget cuts, they don’t want to add anything. We have discussed going back to Medicaid but we only have a few codes and are waiting for more to come up so they can be added all at once. If not for the UOA, most of the medical codes would not be covered by OD’s.