Table 2.
Medicare-Allowable Charges Per Procedure for Non-Facility/ASC Billing
| Medicare Allowables (US $) | |||||
|---|---|---|---|---|---|
| Procedure | Code | Professional Fees | ASC Fees | Pharmaceutical Fees | Total |
| New patient visit (Level 4) | 99204 | 183 | -- | -- | 183 |
| Follow up visit (Level 3) | 99213 | 120 | -- | -- | 120 |
| PPV for MH | 67042 | 1,788 | 1,635 | -- | 3,423 |
| Intravitreal injection | 67028 | 120 | -- | -- | 120 |
| OCT macula | 92134 | 50 | -- | -- | 50 |
| Ocriplasmin | -- | -- | -- | 3,950 | 3,950 |
| Saline | -- | -- | -- | 100 | 100 |
| Maintenance fee ocriplasmin (6% drug cost) | -- | 237 | -- | -- | 237 |
| Maintenance fee saline (6% drug cost) | -- | 6 | -- | -- | 6 |
| Phacoemulsification of cataract | 66984 | 769 | 971 | -- | 1,740 |
| IOL Biometry | 92136 | 98 | -- | -- | 98 |
| Repair of retinal detachment | 67108 | 1,892 | 1,635 | -- | 3,527 |
| Anesthesia fees for VR surgery | 00145 | -- | 255 | -- | 255 |
| Anesthesia fees for cataract surgery | 00142 | -- | 153 | -- | 153 |
US = United States, ASC = ambulatory surgery center, PPV = pars plana vitrectomy, MH = macular hole, OCT = optical coherence tomography, IOL = intraocular lens, VR = vitreoretinal