CPT 99174 & CPT 99177 Reimbursement for Ocular Screening FAQs

Current procedural terminology (CPT®) codes are a set of medical codes that are maintained by, and copyright protected by, the American Medical Association. The code set describes medical, surgical, and diagnostic services. CPT® codes provide information about medical services and procedures and are used by physicians and payers to determine proper coding and payment. CPT® is registered trademark of the American Medical Association.

iScreen Vision recommends the use of CPT® Code 99174 to bill payers for the use of the iScreen Vision Screener 3000. CPT® Code 99174, originally issued in 2008 as “ocular photoscreening with interpretation and report, bilateral,” was revised in 2013 and split into two codes – CPT® Code 99174 and CPT® Code 99177.

CPT® 99174 was renamed Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral; with remote analysis and report. This is the code that is recommended for use with iScreen Vision pediatric vision screening because of the remote analysis performed by our vision analysts.

CPT® 99177 is the code for Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral; with on-site analysis. This is the appropriate reimbursement code for devices that perform analysis with software only and do not use remote analysis by human analysts, like iScreen Vision. Because iScreen Vision’s analysis is performed off-site, or remotely, CPT® 99177 is not recommended for use with iScreen Vision photoscreening, or ocular screening.

Yes. According to the AMA, “A proposal for a new or revised Category I code must satisfy all of the following criteria:”

• “All devices and drugs necessary for performance of the procedure or service have received FDA clearance or approval when such is required for performance of the procedure or service.
• The procedure or service is performed by many physicians or other qualified health care professionals across the United States.
• The procedure or service is performed with frequency consistent with the intended clinical use (i.e., a service for a common condition should have high volume, whereas a service commonly performed for a rare condition may have low volume).
• The procedure or service is consistent with current medical practice.
• The clinical efficacy of the procedure or service is documented in literature that meets the requirements set forth in the CPT® code change application.“

(Source: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/applying-cpt-codes.page?)

Reimbursement rates from payers will vary. AMA uses a Resource-Based Relative Value Scale (RBRVS) to value CPT® codes. The AMA/Specialty Society Relative Value Scale Update Committee (RUC) makes annual recommendations about new and revised physician services to the Centers for Medicare and Medicaid Services (CMS) and reviews RBRVS every five years.

Yes, many national and regional payers cover CPT® Code 99174 and CPT® Code 99177, although coverage limitations vary by insurer, and generally if CPT® Code 99174 is covered by an insurer, they likely will also cover CPT® Code 99177, since these are for the same procedure known as “ocular screening” or “photoscreening” or “instrument-based screening.” Some payers do not have coverage policies related to CPT® Code 99174 or CPT® Code 99177 or decline to cover the procedure. iScreen Vision encourages physicians to contact their payers to determine coverage policies and limitations related to CPT® 99174.

CPT® 99174 & CPT® 99177 Reimbursement FAQs
These FAQs discuss the Current Procedural Terminology Code 99174 (also known as 99174 or CPT® Code 99174 or CPT® 99174), which was originally introduced in 2008 as the code for ocular photoscreening and was modified in 2013 to become two codes for instrument based vision screening (e.g., photoscreening, automated-refraction). CPT® 99174 is the proper code to use for devices like iScreen Vision, which use “remote analysis” by human analysts, while CPT® 99177 should only be used by doctors who are using devices that use software only to perform analysis, known as “on-site analysis.”