Vision care policy, ophthalmological practices and the Medicare program

Medicare specifically excludes routine eye examinations and refractive services. In optometric circles, it is widely believed that ophthalmologists are currently receiving payment for routine eye care and refractive services. A survey of ophthalmologists and optometrists in New York State is presented with respect to their fees and participation in the Medicare program. The use of procedures and diagnosis codes and its impact on billing practices by ophthalmologists is reviewed. Data from a Medicare intermediary and from a provider of health care services raise serious issues regarding Medicare's policy of excluding routine eye care. A review of existing rules and regulations and its implementation appears in order.