Providers should use the glaucoma screening procedure codes when submitting claims in the following instances:
BadgerCare Plus and Medicaid do not limit the frequency, age criteria, or reasons for screening; rather, this is left to best medical judgment based on standard medical practice and the member's individual circumstances.
Claims for screenings must have the diagnosis code field completed (e.g., a preventive code). For example, a claim for a glaucoma screening could indicate ICD diagnosis code Z13.5 (Encounter for screening for eye and ear disorders).
Glaucoma screening examinations are covered when they are performed by or under the direct supervision of an ophthalmologist or optometrist. If a member has a previous history of glaucoma, use the CPT diagnostic procedure code when submitting a claim for services.
A provider will not be separately reimbursed for a glaucoma screening if an ophthalmological exam is provided to the member on the same DOS. Glaucoma screening and diagnostic examinations are included in the reimbursement for the ophthalmological exam.