Table 6 Mix of specific services for cataract episodes in low and high payment ratio counties
HCPCS Code | Procedure Name | Counties in the 1st(lowest) Quartile of the Ratio of Medicare Payments for Surgical to Non-surgical Episodes | Counties in the 4th(highest) Quartile of the Ratio of Medicare Payments for Surgical to Non-surgical Episodes | Ratio of Medicare Payments in the 1stto the 4thQuartiles | ||
|---|---|---|---|---|---|---|
Pct. of Claims | Average Medicare Payment | Pct. of Claims | Average Medicare Payment | |||
66982 | Cataract surgery, complex | 1.3% | $774 | < 1% | -- | -- |
66984 | Cataract surgery w/iol, 1 stage | 22.9 | 682 | 25.7 | $569 | 1.20 |
66821 | After cataract laser surgery | 6.4 | 256 | 6.1 | 218 | 1.18 |
99244 | Office consultation | 1.5 | 137 | 1.5 | 122 | 1.12 |
92004 | Eye exam, new patient | 2.0 | 97 | 2.0 | 87 | 1.12 |
00142 | Anesthesia for procedures on eye; lens surgery | 12.7 | 81 | 13.7 | 62 | 1.32 |
92014 | Eye exam & treatment | 7.3 | 76 | 5.3 | 65 | 1.17 |
92135 | Ophthalmic dx imaging | 1.1 | 43 | < 1% | -- | -- |
99214 | Office/outpatient visit, established patient | 1.6 | 67 | 1.6 | 58 | 1.15 |
92012 | Eye exam established pat | 4.5 | 54 | 2.7 | 46 | 1.20 |
76519 | Echo exam of eye | 6.4 | 53 | 7.2 | 37 | 1.43 |
92136 | Ophthalmic biometry | 5.5 | 52 | 6.6 | 38 | 1.34 |
99213 | Office/outpatient visit, established patient | 2.3 | 43 | 2.2 | 38 | 1.13 |
Q1003 | Ntiol category 3 | 1.6 | 40 | 1.6 | 40 | 1.00 |