BCBSRI has updated its payment policy for Ophthalmology Examinations and Routine Eye Exams for BlueCHiP for Medicare members, effective for dates of service on or after 1 de enero de 2019. The following is a change to the definition of a routine eye exam:

Routine eye exam: The first claim processed by BCBSRI during a calendar year from an ophthalmologist or optometrist reported with Current Procedural Terminology (CPT) codes 92002-92014, S0620, or S0621 will be considered a routine eye exam (regardless of the diagnosis reported on the claim) for benefit application purposes.

For 2019, all BlueCHiP for Medicare members have a $0 copayment/cost share for a routine eye exam. Please note that routine eye exam benefits are generally limited to one exam per year. Please check the member’s specific benefits for details.

For the purposes of benefit application, any subsequent claims (regardless of diagnosis) filed with codes 92002-92014 or any services reported under the 99000 series of Evaluation and Management codes (e.g., 99213) during the calendar year will be considered a medical specialist visit.

Following BCBSRI’s updated definition of a routine exam, any claims with CPT codes 92002-92014 that have been processed and applied a copay to the member’s first office visit in 2019 will be adjusted to reflect that the member doesn’t have a cost share.

BCBSRI expects to start adjusting claims the week of 11 de marzo. As a result, you will start to see the adjusted claims in your future settlements. If your office collected a cost share from the member, you are required to reimburse/refund the member within 45 days of the adjusted date, or you may apply the amount toward an outstanding balance with your office if the member has one.

If you have any questions about these changes, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri.org.