Effective October 1, 2017, Independence made changes to the list of services eligible for payment above capitation for primary care physicians (PCP), as well as to the fee schedule, for CPT^® code 92227.

CPT code 92227 was added to the attachments in the following Independence policies:

• Commercial: #00.10.01x: Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
• Medicare Advantage: #MA00.033d: Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers

The standard medical fee schedule for professional providers was updated to reflect a new rate for this code as of October 1, 2017. To view the new rate, use the Allowance Inquiry transaction on the NaviNet^® web portal. To do so, go to Independence NaviNet Plan Central, select Claim Inquiry and Maintenance from the Independence Workflows menu, and then select Allowance Inquiry. For step-by-step instructions on how to use this transaction, refer to the user guide available in the NaviNet Resources section.

Coding for dilated retinal exams for patients with diabetes

As a reminder, providers may use CPT^® II code 3072F when there is a history of a dilated retinal exam negative for retinopathy the year prior. This code should be submitted on claims for patients who have a diagnosis of diabetes in 2017 but had a dilated retinal exam that was negative for retinopathy in 2016.

By using this code and documenting it in the patient's medical chart, it allows eligible PCPs to receive credit for the dilated retinal exam measure for Independence quality programs. It will also reduce the likelihood of participation in chart reviews for the Centers for Medicare & Medicaid Services' Star Rating Program or the Healthcare Effectiveness Data Information Set (HEDIS^®).

If you have any questions, please contact your Network Medical Director.

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