Ophthalmologists incorrectly reporting HCPCS codes G9890 and G9891 on Medicare claims

May 4, 2018

CMS (Medicare) recently found that some ophthalmologists are reporting G9890 and G9891 in error for services after 12/31/2017, causing claims to deny. These codes were deleted and reissued 4/1/2018 with a different definition and purpose.

G9890: Bridge payment – first session furnished by MDPP supplier to an MDPP beneficiary who has previously received MDPP services from a different MDPP supplier

G9891: MDPP session reported as a line-item on a claim for a payable MDPP services HCPCS G-code for a session furnished by the billing supplier that counts toward achievement of the attendance performance goal for the payable MDPP services HCPCS G-code

These procedure codes can only be reported for Medicare Diabetes Prevention Program (MDPP) services.

Please review the following procedure codes as possible replacement codes, effective for services on or after 1/1/2018.

G9974: Documentation of medical reason(s) for not performing a dilated macular examination

G9975: Documentation of patient reason(s) for not performing a dilated macular examination

You may make the necessary corrections to your claim and resubmit.

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