CMS - Centers for Medicare and Medicaid ServicesSeptember 23, 2021 – Centers for Medicare & Medicaid Services (CMS) and Medicare Learning Network (MLN) released an update regarding newly covered glaucoma screening services for FQHC & RHC. Updates include new revenue codes for FQHC & RHC.


Highlights from the Medicare Learning Resources (MLR) fact sheet:

We cover high-risk patients’ annual glaucoma screenings in at least 1 of these groups:

  • Patients with diabetes mellitus
  • Patients with family history of glaucoma
  • African-Americans aged 50 and older
  • Hispanic-Americans aged 65 and older

A covered glaucoma screening includes:

  • Dilated eye exam with intraocular pressure measurement
  • Direct ophthalmoscopy exam, or slit-lamp biomicroscopic exam

Medical record documentation must show the patient’s high-risk group.

Use diagnosis code Z13.5—Encounter for screening for eye and ear disorders, to bill glaucoma screening claims.

Rural Health Clinic (RHC) paid under All-Inclusive Rate (AIR); include diagnosis code— use revenue code 770

Federally Qualified Health Center (FQHC)—use revenue code 770

Table 3. Glaucoma Screening Billing & Coding

Code Descriptor
G0117 Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist
G0118 Glaucoma screening for high-risk patient furnished under the direct supervision of an optometrist or ophthalmologist

Table 3’s type of service code is Q. Applicable glaucoma screening service types of bill include: 13X, 22X, 23X, 71X, 73X, 75X, and 85X.

Read the complete fact sheet here.