AOA advises members to withhold specular microscopy claims

February 25, 2013

The AOA Washington office is warning optometrists that Current Procedural Terminology (CPT) Code 92286 is misvalued in the 2013 Medicare fee schedule and, as a result, AOA members should consider withholding claims for this code until the AOA can confirm payment amounts have been corrected.

The Centers for Medicare & Medicaid Services has been alerted to the misvaluation of CPT Code 92286, anterior segment imaging with interpretation and report; with specular microscopy and endothelial call analysis, and agency officials are now working to correct the problem.

Once the error has been fixed, the AOA anticipates that the accurate payment would be applied retroactively to Jan. 1. However, in an effort to avoid administrative hassles, the AOA is urging members to withhold CPT Code 92286 claims until the local Medicare contractor begins paying the correct amount.

AOA members should monitor AOA First Look for additional updates and check the AOA News blog for the latest updates on this and other important topics. AOA members with questions or concerns should contact the AOA Washington office team at 800-365-2219 or ImpactWashingtonDC@aoa.org.


One comment

  1. There is no sound reason to hold claims for this issue. If, in fact, there is an issue with the RVUs, when CMS issues a MedLearn Matters corrective action and follows that with a Change Request to all MACs and Carriers/Intermediaries, the claims will be re-adjudicated by each of these payers, and corrected payments will be issued.

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