C is for CPT Code.
CPT Codes are how physicians are reimbursed for medical procedures. The CPT code for instrument-based ocular screening such as photoscreening is CPT Code 99174.
Answers to Frequently Asked Questions
What is a current procedural terminology (CPT® code)?
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.
What CPT® code should users of iScreen Vision use?
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 is now known as “instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral.”
Is CPT® Code 99174 a Category I code?
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.“
What are the Relative Value Units (RVUs) associated with CPT® Code 99174?
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.
Do any national insurance companies cover CPT® Code 99174?
Yes, many national and regional payers cover CPT® Code 99174, although coverage limitations vary by insurer, and some payers do not have coverage policies related to CPT® Code 99174 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 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 a code for instrument based vision screening (e.g., photoscreening, automated-refraction).