Summary & Overview
HCPCS G0117: Glaucoma Screening for High-Risk Patients
HCPCS Level II code G0117 covers glaucoma screening services provided by optometrists or ophthalmologists for patients classified as high risk. Glaucoma is a leading cause of irreversible vision loss; early detection through targeted screening plays a role in identifying patients who may need diagnostic follow-up and treatment. Nationally, standardized screening codes like G0117 help payers and providers align on billing for preventive ophthalmic services and support access to vision care for higher-risk populations.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, typical sites of service, and how G0117 is used in clinical workflows. Readers will find concise benchmarks where available, an explanation of clinical context for glaucoma screening, and notes on documentation expectations tied to this screening code. The summary highlights national implications for access to preventive eye care and how a designated HCPCS Level II screening code supports consistent billing for optometrists and ophthalmologists. Data not available in the input indicates specific payer policies, utilization rates, and related diagnosis codes are not provided here.
Billing Code Overview
HCPCS Level II code G0117 represents glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist. The service is a screening exam to detect glaucoma in patients identified as at increased risk and is performed by eye care specialists.
Service Type: Glaucoma screening
Typical Site of Service: Eye clinic or ophthalmology/optometry office
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a family history of glaucoma and previously diagnosed ocular hypertension presents to an ophthalmology clinic for a targeted glaucoma screening performed by an ophthalmologist. The patient reports gradual peripheral vision changes and intermittent headaches. The clinical workflow begins with clinic intake and medical history review, chief complaint documentation, and visual acuity measurement. The ophthalmologist or optometrist performs intraocular pressure measurement (tonometry), anterior segment exam with slit lamp, optic nerve head assessment (direct/indirect ophthalmoscopy or fundus photography), and visual field screening when indicated. Results that suggest glaucoma or increased risk prompt documentation of findings, counseling of the patient, and scheduling of definitive diagnostic testing or referral for ongoing glaucoma management. Billing uses HCPCS Level II code G0117 to report a glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist, appended with appropriate modifiers to indicate professional component, unusual services, or other billing circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing the professional interpretation or evaluation portion separately from technical services |