Table 1.
Medicare-Allowable Charges Per Procedure for Hospital-Based Billing
| Medicare Allowables (US $) | |||||
|---|---|---|---|---|---|
| Procedure | Code | Professional Fees | Hospital Fees | Pharmaceutical Fees | Total |
| New patient visit (Level 4) | 99204 | 145 | 128 | -- | 273 |
| Follow up visit (Level 3) | 99213 | 55 | 74 | -- | 128 |
| PPV for MH | 67042 | 1,788 | 2,914 | -- | 4,702 |
| Intravitreal injection | 67028 | 118 | 232 | -- | 350 |
| OCT macula | 92134 | 50 | 48 | -- | 99 |
| Ocriplasmin | -- | -- | -- | 3,950 | 3,950 |
| Saline | -- | -- | -- | 100 | 100 |
| Maintenance fee ocriplasmin (6% of drug cost) | -- | -- | 237 | -- | 237 |
| Maintenance fee saline (6% of drug cost) | -- | -- | 6 | -- | 6 |
| Phacoemulsification of cataract | 66984 | 769 | 1,730 | -- | 2499 |
| IOL Biometry | 92136 | 98 | 74 | -- | 173 |
| Repair of retinal detachment | 67108 | 1,892 | 2,914 | -- | 4,806 |
| Anesthesia fees for VR surgery | 00145 | -- | 255 | -- | 255 |
| Anesthesia fees for cataract surgery | 00142 | -- | 153 | -- | 153 |
US = United States, PPV = pars plana vitrectomy, MH = macular hole, OCT = optical coherence tomography, IOL = intraocular lens, VR = vitreoretinal