Health Care Services Advisory Committee
October 30, 2019
Page 3
Dr. Becker provided a presentation on low vision treatment which relates to adaptability
to every-day tasks associated with eye disease or trauma. This treatment does not fall
within the 92000 series of codes. These are specialized services that general
optometry does not handle. There are only a few providers that deal with this specialty.
Dr. Burgess handles the rehabilitation aspect of optometry related to traumatic brain
injury. This area of eyecare deals with visual processing where there are not issues
related to the health of the eye, but rather how the information is processed by the
brain. She also prescribes therapeutic lenses for treatment of this condition. Dr.
Burgess receives referrals from many other areas of practice because of her specialized
expertise. Other medical providers in other specialties do not offer this type of
treatment. This particular area of medicine has developed over the last 20 years and
the current rules and fee schedule do not account for these advances in treatment. For
prior workers’ compensation claims, Dr. Burgess always provided documentation to
support the treatment and the procedures were approved and paid by insurance
carriers. The recent rule interpretation change by some carriers has led to patients not
receiving necessary treatment due to lack of reimbursable billing codes.
The proposed changes remove reference to specific codes from Rule 208(4) to not limit
treatment and inserts language “that most accurately reflect the services rendered
including those for rehabilitative care and extraction.” Mr. Williams feels this will resolve
the majority of billing issues. Additionally, he requested scope of practice for
rehabilitative services under MCL 333.17401 and R338.301 be included in Rule 208(5).
Mr. Williams presented the optometry scope of practice as it existed in 1992 and
outlined the subsequent changes to the scope of practice since 1992. He pointed out
that the requested rule changes would be in compliance with Section 315 of the Act,
which limits reimbursement for optometry to the definition of the practice of optometry
under the public health code as of May 20, 1992.
Paul Kauffman indicated AF Group would be willing to pay for this treatment if is
beneficial, but he would like medical research that documents the effectiveness. He
indicated he will reach out to AF Group specialists for further discussion. Discussion
ensued about removal of foreign objects from the eye and an optometrist’s inability to
treat because of absence of billing framework for their profession.
Jason Chizick expressed concern that the rule changes may be too general and
possibly invite more denials by insurance companies because of the lack of specificity.
Should we include something more detailed to reduce denials?
Mark is open to making a rule change in some form to bring the codes up-to-date with
current treatment. This subject, along with ground ambulance payment, will be
discussed at the next meeting.
Proposed Meeting Dates
Dave presented proposed 2020 meeting dates. The next meeting will be in February.
Mark reiterated the requirement that we meet two times per year.