Because recent studies have advocated for the use of selective laser trabeculoplasty (SLT) as a primary glaucoma therapy,¹ and because optometrists are allowed to do the procedure in 9 states,* this article will review proper coding for SLT.

* Selective Laser Trabeculoplasty (SLT) is a procedure that can be performed by optometrists in 10 states in the United States (Alaska, Arkansas, Colorado, Indiana, Kentucky, Louisiana, Oklahoma, Wisconsin, Wyoming, and Virginia), according to a representative of the American Optometric Association. However, the regulations can vary by state, so it’s important to check the specific laws in your location.

Reimbursable uses  

 Some policies may cover SLT as a first line of treatment for open angle glaucoma (OAG) and  some payors only authorize SLT if the patient cannot tolerate anti-glaucoma medications or will not comply with their prescribed eyedrops. Therefore, document drug intolerance or noncompliance in the medical record prior to SLT.

Be sure to check with your payer policy for guidance.

Reporting

CPT code 65855, Trabeculoplasty by laser surgery, one or more sessions (defined treatment series) is used to report the service. This is the same code used for argon laser trabeculoplasty (ALT), since CPT is agnostic to the type of laser. CMS assigned CPT 65855 a 10-day global period, so it is classified as a minor procedure for reimbursement purposes.

For bilateral surgery, Medicare guidelines direct you to report bilateral SLT as 65855-50 with a quantity of “1”. Under the multiple procedure rules, reimbursement is based on 150% of the Medicare allowable for a single procedure.

To indicate the unrelated SLT procedure on the fellow eye in the global period of the first eye, use modifier 79 with 65855 on your claim. Location modifiers RT or LT are also helpful. 

Medicare CPT code 65855 for SLT is classified as a minor procedure with a 10-day global period. This means that any related postoperative care within this 10-day period, such as an office visit for a postoperative intraocular pressure (IOP) rise in the treated eye, is not separately billable.

However, an office visit on the same day as SLT may be billable if there is a separately identifiable reason for the visit. If the only reason for the visit is to determine the need for SLT, that visit is not separately billable.

The frequency of SLT performance and billing depends on various factors, including the patient’s medical condition and the health care provider’s judgment.

When the eye care professional believes additional treatment is medically necessary and properly documents the rationale for repeating it outside of the 10-day global period, it is covered.  Repeat treatments are supported in the literature as effective.^2,3,4

A valuable tool

SLT, provided it is available to optometrists in your state, can be a valuable tool for managing glaucoma, and proper coding can assist with that. OM

References

1. Zgryźniak A, Przeździecka-Dołyk J, Szaliński M, Turno-Kręcicka A. Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review. J Clin Med. 2021;10(15):3307. doi: 10.3390/jcm10153307.
2. Polat J, Grantham L, Mitchell K, Realini T. Repeatability of selective laser trabeculoplasty. Br J Ophthalmol. 2016;100(10):1437-1441. doi: 1136/bjophthalmol-2015-307486
3. Lai J, Bournais TE. Repeatability of Selective Laser Trabeculoplasty (SLT).  Invest Ophthalmol Vis Sci.  2005;46: 119.
4. Hong BK, Winer JC et al. Repeat selective laser trabeculoplasty.  J Glaucoma.  2009;18(3):180-183. doi: 10.1097/IJG.0b013e31817eee0b

MS. SPERRY is an associate consultant for Corcoran Consulting Group, which specializes in coding and reimbursement issues for ophthalmology and optometry practices. Contact her at bsperry@corcoranccg.com or at (800) 399-6565, ext 238.