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Medicaid provider rate increases

Posted By Chet Seward, Tuesday, July 15, 2014

CSEPS joined a number of medical societies and other stakeholders to advocate for increased reimbursement rates for ophthalmologists within Medicaid during the last legislative session. (Read the letter CSEPS sent to the state here.) Access to much needed specialty care has been hampered for some time given low reimbursement rates that frequently do not cover an ophthalmologist’s costs associated with providing care.

The General Assembly and Governor Hickenlooper approved a 2% increase for most fee-for-service benefits including physician and clinic services and vision services.In addition, the legislature approved a series of targeted rate increases for specific providers, codes and specialties. According to a Department of Health Care Policy and Financing fact sheet, “These (targeted) increases are intended to address large inequities in rates and to demonstrate the Department’s priority to pay for services that provide high value for clients.” The objective was to raise codes from current levels to approximately 80% of Medicare rates. Be aware that the following eye codes were positively affected by these changes:

  • Code 92002 – Eye exam, new patient
  • Code 92004 – Eye exam, new patient
  • Code 92012 – Eye exam established patient
  • Code 92014 – Eye exam & treatment
  • Code 92018 – New eye exam & treatment
  • Code 92019 – Eye exam & treatment
  • Code 92020 – Special eye evaluation
  • Code 92060 – Special eye evaluation
The June 2014 Medicaid Provider Bulletin provides more details about both the across the board and targeted rate increases.

Tags:  2014 legislative session  advocacy  Medicaid  reimbursement 

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