Effective October 1, 2017, AmeriHealth made changes to the list of services eligible for payment above capitation for primary care physicians, as well as to the fee schedule, for CPT^® code 92227.

CPT code 92227 was added to the attachments in Claim Payment Policy #00.10.01x: Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers.

The standard medical fee schedule for professional providers was updated to reflect a new rate for this code as of October 1, 2017. To view the new rate, use the Allowance Inquiry transaction on the NaviNet^® web portal. To do so, go to AmeriHealth NaviNet Plan Central, select Claim Inquiry and Maintenance from the AmeriHealth Workflows menu, and then select Allowance Inquiry. For step-by-step instructions on how to use this transaction, refer to the user guide available in the NaviNet Resources section.

Coding for dilated retinal exams for patients with diabetes

As a reminder, providers may use CPT^® II code 3072F when there is a history of a dilated retinal exam negative for retinopathy the year prior. This code should be submitted on claims for patients who have a diagnosis of diabetes in 2017 but had a dilated retinal exam that was negative for retinopathy in 2016.

If you have any questions, please contact your Provider Partnership Associate or your Network Medical Director.

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