- VERA FY 2023 has no changes in the codes that trigger VERA for eye: please remember to code the visual impairment codes. They can be used as secondary codes to trigger VERA funding. Attached is a copy of the visual impairment codes that trigger VERA funds along with a VERA price hierarchy. Many of these patients may only be seen in primary care optometry clinics so please make sure we are not missing out on any VERA funds.
- Per HIMS for prolong codes ( use with 99205 or 99215)
Within the VA, use the 99417 code with the AMA time frames, unless CPAC (Consolidated Patient Account Center) request/informs the clinic otherwise. The time difference results in increased RVU’s for those individuals using time coding. (low vision, traumatic/acquired brain injury, complicated cases requiring additional case management etc):
For new pts: 99205:
| Less than 75 min | no prolong code used |
| 75-89 minutes: | 99205 and 1 unit 99417 |
| 90-104 min | 99205 and 2 units 99417 |
| 105min or more | 99205 and 3 units 99417 plus 1 additional unit for each additional 15 min increment |
For Est patients: 99215
| Less than 55 min | no prolong code used |
| 55-69 min | 99215 and 1 unit 99417 |
| 70-84 min | 99215 and 2 units 99417 |
| 85 min or more | 99215 and 3 units 99417 plus 1 additional unit for each additional 15 min increment |
** please keep in mind the 99417 codes are not approved by CMS and therefore do not match the times set by CMS; but VA is allowing the use of these codes until otherwise indicated. For locations that are using time based coding or have very difficult cases in primary care, time based coding may be helpful for RVU capture.***
- Family therapy codes: Codes such as 96167 or 96170 health behavior assessment and intervention procedures are for only nonphysician practitioners. Since optometrists have authority to bill CMS the same as physicians or other qualified healthcare professionals(QHP), it is recommended that they should not use those codes. Instead, E&M codes are recommended.
Article – Billing and Coding: Health and Behavior Assessment/Intervention (A57754) (cms.gov)