Insurances such as Aetna and BlueCross consider laser photocoagulation of macular drusen as an investigational procedure for the treatment of age-related macular degeneration, a disease that causes progressive damage to the central part of the retina. However, a CPT code 0017T was introduced in 2002 to indicate destruction of macular drusen through photocoagulation. The laser used in the above procedure is FDA approved and some state mandates prohibit denials of FDA-approved techniques.

Knowing the information that is available, what can an ophthalmologist do to get paid. Does she avoid doing the procedure? Or does she perform the procedure with the assumption that she might not get paid for it. What if the patient requests it? Would she bill the patient at the outset or try billing the insurance company?

The specialty-based expertise of NextServices comes into play exactly in situations like the above. Understanding the depth of a specialty is important to us before we undertake the responsibility of billing and getting the specialist reimbursed. Our training programs are developed in a specialty-centric manner that educates our staff in clinically following what the ophthalmologist does.

Our approach results in more assured reimbursements for our clients.