Medicare Updates: Deductibles and Coding

Medicare Part B Premium and Deductible

What changed: The 2011 Medicare Part B premium was $115.40, so the 2012 $99.90 premium price is a $15.50 decrease.

The Medicare Part B 2012 deductible will be $22 lower at $140.  This deductible is covered under Medigap Plan F and Medigap Plan C.

Who will it affect: Seniors enrolled in Medicare Part B during 2011 paid a monthly premium of $115.40 for physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items and receive more from their monthly social security check.


Coding Alert

Although Medicare doesn’t allow you to bill for regular refractive lenses, you could still claim reimbursement for contact lens prescriptions to treat keratoconus (ICD-9 codes 371.60-371.62) and ocular surface disorders like corneal abrasions and dry eye.  However, your choice is going to change very soon as your familiar CPT code is going to be deleted in 2012.

92070 (deleted): The CPT 2012 manual deletes your reliable code for therapeutic contact lenses, 92070 (Fitting of contact lens for treatment of disease, including supply of lens).  In its place, you’ll find two new codes:

  1. 92071 (Fitting of contact lens for treatment of ocular surface disease)
  2. 92072 (Fitting of contact lens for management of keratoconus, initial fitting).

Note: You cannot report 92071 with 92072, according to the CPT manual.  For the supply of lenses, which was earlier included in the code, CPT 2012 suggests reporting 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or other materials provided), or another appropriate supply code.

A note with the new code 92072 suggests that coders should report an appropriate E/M or General Ophthalmological Services (92002-92014) code for subsequent fittings of keratoconic lenses.


Vision Services – Nonsurgical Codes Discontinued

92070, 92120, and 92130


92071 and 92072