Another great benefit of being an FSO member is that the Board is comprised of committees that are chaired by fellow members who are dedicated to making the practice of medicine better. Over the last 10 years, your third party committee has been working hard behind the scenes and have helped draft, edit and establish with First Coast Service Options (FCSO) the following local coverage determinations listed below. A “local coverage determination” (LCD) means a determination by a Medicare carrier respecting whether or not a particular item or service is covered by Medicare and what the coverage indications, limitations, and/or medical necessity are in order to be reimbursed for that item or service.

LCD                        POLICY TITLE

L36237                  Amniotic membrane – sutureless placement on the ocular surface

L33274                  Botulinum toxins

L33808                  Cataract extraction

L33810                  Computerized corneal topography

L36232                  Diagnostic evaluation and medical management of moderate-severe dry eye disease (DED)

L33819                  External ocular photography

L33997                  Fluorescein angiography

L33670                  Fundus photography

L33377                  Implantable miniature

L33911                  Indocyanine-green angiography

L33504                  Intravitreal bevacizumab (Avastin)

L33914                  Iridotomy by laser surgery

L33917                  Laser trabeculoplasty

L33919                  Macugen (pegaptanib sodium injection)

L33705                  Ocular photodynamic therapy (OPT) with Verteporfin

L33925                  Ophthalmological diagnostic services

L34017                  Ophthalmoscopy

L33729                  Optical coherence biometry

L33407                  Ranibizumab (Lucentis)

L33751                  Scanning computerized ophthalmic diagnostic imaging

L34028                  Upper eyelid and brow surgical procedures

L33766                  Visual field examination

L33968                  YAG laser capsulotomy

As you all know, the conversion to ICD-10 occurred on October 1, 2015. Crosswalks between ICD-9 lists of covered diagnoses for certain services and the comparable ICD-10 diagnoses were imperfect in some LCDs, such as the Visual Field Testing LCD.  First Coast Service Options was made aware of this problem and corrected the disparities with assistance provided by the FSO Third Party Liaison Committee.

Please feel free to contact the FSO should you have questions or need assistance in addressing any third party payer issues. We are also encouraging members to participate in the survey on Third Party Hassle Factors that is on the FSO website. We are cataloging the issues and then will address top tier items with suggested solutions derived from other members or engage in consultation with other experts