Evaluation of Dry Eyes
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Defines Blue Cross Blue Shield of New Mexico reimbursement stance for laboratory/testing related to evaluation of dry eye disease, and explains which tear tests are reimbursable or not for covered members and providers.
No material clinical or coverage changes in this revision.
Dry Eye Testing Coverage Criteria
Dry eye testing coverage criteria
Reimbursement Information
Procedure Codes and Coding Examples
Documentation and Claims Submission Requirements
Documentation and claims submission — submit accurate documentation and valid codes; claims subject to edits
Providers must submit accurate documentation of services performed and file claims using valid code combinations from HIPAA‑approved code sets. Claims should be coded according to industry standard coding guidelines (for example, UB Editor, AMA CPT Assistant, HCPCS, ICD‑10‑CM/PCS, NDC, DRG guidelines, CMS NCCI Policy Manual and CCI table edits). Claims are subject to code edit protocols and may be reviewed; upon request, providers must submit additional documentation to support the claim.
- Use valid code combinations from HIPAA‑approved code sets when submitting claims.
- Code claims per industry-standard guidelines including CPT, HCPCS, ICD-10, NDC, DRG, CMS NCCI edits and related resources.
- Be prepared for code-edit protocol adjustments and claim review; promptly provide additional documentation if requested.
Test Definitions
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