How much will ODs make through Medicare in 2014?

In 2014, ODs will be paid $1.1 billion by Medicare, according to estimates from the Centers for Medicare and Medicaid Services (CMS)—a 4 percent increase from last year.

"They're paying us more per service, and they're paying us to do more services."

Medicare payments for optometrists this year will be a mixed bag. However, compared to other healthcare providers, payment rates for optometry have grown steadily over the past 10 years.

The increase for 2014 would have been higher had it not been for adjustments to the Medicare Economic Index (MEI), a price index that helps determine Medicare payments using such factors as practice expenses, work and the cost of malpractice insurance.

This year's MEI changes included a shift in importance from practice expenses to work, which means slightly lower payment for ODs, explained Rodney Peele, the AOA's assistant director for regulatory policy and outreach.

"Our doctors benefit more when payments for practice expenses go up because they use a lot of expensive equipment," he said.

A decade of growth

There are a couple of notable changes to OD codes for 2014:

  • 13.7 percent increase in the code for contact lens fitting, and
  • 18.5 percent decrease for the visual evoked potential test, a neurological test that helps diagnose disease of the optic nerve.

Collectively ODs are making 83 percent more on Medicare physician services than they did in 2004—a difference of about $500 million. This is due to increased market share for medical eye care, increased participation in Medicare and higher relative values assigned to primary eye care.

"The AOA is partly responsible for these factors because we've encouraged members to be covered under Medicare and do more medical eye care," Peele said.

"We pay close attention to the way the codes that ODs use are valued, and we work in tandem with ophthalmology to make sure those eye services are paid fairly." The AOA also fights against policies restricting access or cutting down on OD services.

All these factors have contributed to steadily rising Medicare payments. "They're paying us more per service, and they're paying us to do more services," Peele said.

Pay attention to the SGR fight

Despite the good news on OD payments overall, Medicare's sustainable growth rate formula (SGR) threatens to cut Medicare payments by 24 percent this year unless Congress steps in.

The AOA will help members stay aware of any changes lawmakers take in coming months to extend a temporary fix to the SGR formula—which expires at the end of March—or to permanently replace the flawed formula.

The rise of Medicare OD payments

Below is a sample of the payment increases optometry has experienced since 2011:

Established patient eye exam (92012): 9.0 percent increase

  • Eye exam and treatment (92014): 8.8 percent increase
  • New patient eye exam (92004): 8.0 percent increase
  • Eye exam with photos (92250): 7.9 percent increase
  • Established patient office visit (99213): 6.0 percent increase

January 30, 2014

comments powered by Disqus