South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:50 - Optometry › Chapter 20:50:04 - Code of ethics › Appendix A

Current through Register Vol. 51, page 10, July 15, 2024
Optometric Clinical Procedures Approved by South Dakota
				  Board of Optometry
(Within this Appendix, the word "Physician(s)" refers
				  to Optometrist(s))
CPT Code
Description of Clinical Procedure
Notes/Comments
11200
Removal of skin tags, multiple fibrocutaneous tags,
							 any area; up to and including 15 lesions.
11201
Each additional ten lesions (list separately in
							 addition to code for primary procedure).
17250
Chemical cauterization of granulation tissue (proud
							 flesh, sinus or fistula).
65205
Removal of foreign body, external eye; conjunctival
							 superficial.
65210
Removal of foreign body, external eye; conjunctival
							 embedded (includes concretions), subconjunctival, or scleral
							 nonperforating.
65220
Removal of foreign body, external eye; corneal,
							 without slit lamp.
65222
Removal of foreign body, external eye; corneal, with
							 slit lamp.
65275
Repair of laceration; cornea, nonperforating, with or
							 without removal foreign body.
65430
Scraping of cornea, diagnostic, for smear and/or
							 culture.
65435
Removal of corneal epithelium; with or without
							 chemocauterization (abrasion, curettage).
65600
Multiple punctures of anterior cornea (e.g., for
							 corneal erosion, tattoo).
65778
Placement of amniotic membrane on the ocular surface;
							 without sutures.
66999
Unlisted procedure, anterior segment of eye.
67820
Correction of trichiasis; epilation, by forceps
							 only.
67850
Destruction of lesion of lid margin (up to 1
							 cm).
67938
Removal of embedded foreign body, eyelid.
68020
Incision of conjunctiva, drainage of cyst.
68136
Destruction of lesion, conjunctiva.
68040
Expression of conjunctival follicles (e.g., for
							 trachoma).
68761
Closure of the lacrimal punctum; by plug,
							 each.
68801
Dilation of lacrimal punctum, with or without
							 irrigation.
68810
Probing of nasolacrimal duct, with or without
							 irrigation.
68840
Probing of lacrimal canaliculi, with or without
							 irrigation.
76511
Ophthalmic ultrasound, echography, diagnostic; A-scan
							 only, with amplitude quantification.
76512
Ophthalmic ultrasound, echography, diagnostic;
							 contact B-scan (with or without simultaneous A-scan).
76514
Ophthalmic ultrasound, echography, diagnostic;
							 corneal pachymetry unilateral or bilateral (determination of corneal
							 thickness).
76516
Ophthalmic biometry by ultrasound echography,
							 A-scan.
76519
Ophthalmic biometry by ultrasound echography, A-scan;
							 with intraocular lens power calculation.
76529
Ophthalmic ultrasonic foreign body
							 localization.
82785
Ige (allergy) tear film test.
83520
Unlisted tear immunoassay, e.g., lactoferrin.
83861
Microfluidic analysis utilizing integrated collection
							 and analysis device, tear osmolarity.
92002
Ophthalmological services: medical examination and
							 evaluation with initiation of diagnostic and treatment program; intermediate,
							 new patient.
92004
Ophthalmological services: medical examination and
							 evaluation with initiation of diagnostic and treatment program; comprehensive,
							 new patient, one or more visits.
92012
Ophthalmological services: medical examination and
							 evaluation, with initiation or continuation of diagnostic and treatment
							 program; intermediate, established patient.
92014
Ophthalmological services: medical examination and
							 evaluation, with initiation or continuation of diagnostic and treatment
							 program; comprehensive, established patient, one or more visits.
92015
Determination of refractive state.
92018
Ophthalmological examination and evaluation, under
							 general anesthesia, with or without manipulation of globe for passive range of
							 motion or other manipulation to facilitate diagnostic examination;
							 complete.
92020
Gonioscopy (separate procedure).
92025
Computerized corneal topography, unilateral or
							 bilateral, with interpretation and report.
92060
Sensorimotor examination with multiple measurements
							 of ocular deviation (e.g., restrictive or paretic muscle with diplopia) with
							 interpretation and report (separate procedure).
92065
Orthoptic and/or pleoptic training, with continuing
							 medical direction and evaluation.
92071
Fitting of a contact lens for treatment of ocular
							 surface disease.
92072
Fitting contact lens for management of keratoconus,
							 initial fitting.
92081
Visual field examination, unilateral or bilateral,
							 with interpretation and report; limited examination (e.g., tangent screen,
							 Autoplot, arc perimeter, or single stimulus level automated test, such as
							 Octopus 3 or 7 equivalent).
92082
Visual field examination, unilateral or bilateral,
							 with interpretation and report; intermediate examination (e.g., at least 2
							 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold
							 screening program, Humphrey suprathreshold automatic diagnostic test, Octopus
							 program 33).
92083
Visual field examination, unilateral or bilateral,
							 with interpretation and report; extended examination (e.g., Goldmann visual
							 fields with at least 3 isopters plotted and static determination within the
							 central 30, or quantitative, automated threshold perimetry, Octopus program
							 G-l, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2,
							 24-2, or 30/60-2).
92100
Serial tonometry (separate procedure) with multiple
							 measurements of intraocular pressure over an extended time period with
							 interpretation and report, same day (e.g., diurnal curve or medical treatment
							 of acute elevation of intraocular pressure).
92120
Tonography with interpretation and report, recording
							 indentation tonometer method or perilimbal suction method.
92130
Tonography with water provocation.
92133
Scanning computerized ophthalmic diagnostic imaging,
							 posterior segment, with interpretation and report, unilateral or bilateral;
							 optic nerve.
92134
Scanning computerized ophthalmic diagnostic imaging,
							 posterior segment, with interpretation and report, unilateral or bilateral;
							 retina.
92136
Ophthalmic biometry.
92140
Provocative tests for glaucoma, with interpretation
							 and report, without tonography.
92225
Ophthalmoscopy, extended, with retinal drawing (e.g.,
							 for retinal detachment, melanoma), with interpretation and report;
							 initial.
92226
Ophthalmoscopy, extended, with retinal drawing (e.g.,
							 for retinal detachment, melanoma), with interpretation and
							 report-subsequent.
92250
Fundus photography with interpretation and
							 report.
92260
Ophthalmodynamometry.
92270
Electro-oculography, with interpretation and
							 report.
92275
Electroretinography, with interpretation and
							 report.
92283
Color vision examination, extended, e.g.,
							 anomaloscope or equivalent.
92284
Dark adaptation examination, with interpretation and
							 report.
92285
External ocular photography with interpretation and
							 report for documentation of medical progress (e.g., close-up
							 photography,
slit lamp photography, goniophotography,
							 stereo-photography).
92286
Special anterior segment photography with
							 interpretation and report; with specular endothelial microscopy and cell
							 count.
92310
Prescription of optical and physical characteristics
							 of and fitting of contact lens, with medical supervision of adaptation; corneal
							 lens, both eyes except for aphakia.
92311
Prescription of optical and physical characteristics
							 of and fitting of contact lens, with medical supervision of adaptation; corneal
							 lens for aphakia, one eye.
92312
Corneal lens for aphakia, both eyes.
92313
Prescription of optical and physical characteristics
							 of and fitting of contact lens, with medical supervision of adaptation;
							 corneoscleral lens.
92314
Prescription of optical and physical characteristics
							 of and fitting of contact lens, with medical supervision of adaptation and
							 direction of fitting by independent technician; corneal lens, both eyes, except
							 for aphakia.
92315
Prescription of optical and physical characteristics
							 of contact lens, with medical supervision of adaptation and direction of
							 fitting by independent technician; corneal lens for aphakia, one eye.
92316
Corneal lens for aphakia, both eyes.
92317
Corneoscleral lens.
92325
Modification of contact lens (separate procedure),
							 with medical supervision of adaptation.
92326
Replacement of contact lens.
92340
Fitting of spectacles, except for aphakia,
							 monofocal.
92341
Bifocal.
92342
Multifocal, other than bifocal.
92352
Fitting of spectacle prosthesis for aphakia;
							 monofocal.
92353
Multifocal.
92354
Fitting of spectacle mounted low vision aid; single
							 element system.
92355
Telescopic or other compound lens system.
92358
Prosthesis service for aphakia, temporary (disposable
							 loan, including materials).
92370
Repair and refitting spectacles; except
							 aphakia.
92371
Spectacle prosthesis for aphakia.
92499
Unlisted ophthalmological service or
							 procedure.
e.g., corneal topography
95930
Visual evoked potential (VEP) testing central nervous
							 system, checkerboard or flash.
97003
Occupational therapy evaluation.
97004
Occupational re-evaluation.
97530
Therapeutic activities, direct (one on one) patient
							 contact by the provider (use of dynamic activities to improve functional
							 performance), each 15 minutes.
97532
Development of cognitive skills to improve attention,
							 memory, problem solving, (includes compensatory training), direct (one-on-one)
							 patient contact by the provider, each 15 minutes.
Low Vision
97533
Sensory integrative techniques to enhance sensory
							 processing and promote adaptive responses to environmental demands, direct
							 (one-on-one) patient contact by the provider, each 15 minutes.
Low Vision
97535
Self-care/home management training (e.g., activities
							 of daily living (ADL) and compensatory training meal preparation safety
							 procedures and instructions in use of assistive technology devices/adaptive
							 equipment) direct one-on-one contact by provider, each 15 minutes.
Low Vision
97537
Community/work reintegration training (e.g.,
							 shopping, transportation, money management, avocational activities and/or work
							 environment/modification analysis, work task analysis), direct one-on-one
							 contact by provider, each 15 minutes.
Low Vision
99050
Services provided in the office at times other than
							 regularly scheduled office hours, or days when the office is normally closed
							 (e.g., holidays, Saturday or Sunday), in addition to basic service.
99051
Services provided in the office during regularly
							 scheduled evening, weekend, or holiday office hours, in addition to basic
							 service.
99053
Services provided between 10 p.m. and 8 a.m. at 24
							 hour facility, in addition to basic service.
99070
Supplies and materials (except spectacles) provided
							 by the physician over and above those usually included with the office visit or
							 other services rendered (list drugs, trays, supplies, or materials
							 provided).
99172
Visual function screening, automated or
							 semi-automated bilateral quantitative determination of visual acuity, ocular
							 alignment, color vision by pseudiosochromatic plates, and field of vision (may
							 include all or some screening of the determination(s) for contrast sensitivity,
							 vision under glare).
(This service must employ graduated visual acuity
							 stimuli that allow a quantitative determination of visual acuity (e.g., Snellen
							 chart). This service may not be used in addition to a general ophthalmological
							 service or an E/M service.)
99173
Screening test of visual acuity, quantitative,
							 bilateral.
(The screening test used must employ graduated visual
							 acuity stimuli that allow a quantitative estimate of visual acuity (e.g.,
							 Snellen chart). Other identifiable services unrelated to this screening test
							 provided at the same time may be reported separately (e.g., preventive medicine
							 services). When acuity is measured as part of a general ophthalmological
							 service or of an E/M service of the eye, it is a diagnostic examination and not
							 a screening test.)
99201
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: a
							 problem focused history; a problem focused examination; and straightforward
							 medical decision making. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually, the presenting problems are
							 self-limited or minor. Physicians typically spend 10 minutes face-to-face with
							 the patient and/or family.
99202
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: an
							 expanded problem focused history; an expanded problem focused examination; and
							 straightforward medical decision making. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the presenting
							 problem(s) are of low to moderate severity. Physicians typically spend 20
							 minutes face-to-face with the patient and/or family.
99203
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: a
							 detailed history; a detailed examination; and medical decision making of low
							 complexity. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually the presenting problem(s) are of
							 moderate severity. Physicians typically spend 30 minutes face-to-face with the
							 patient and/or family.
99204
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: a
							 comprehensive history; a comprehensive examination; and medical decision making
							 of moderate complexity. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually, the presenting problem(s) are
							 of moderate to high severity. Physicians typically spend 45 minutes
							 face-to-face with the patient and/or family.
99205
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: a
							 detailed history; a detailed examination; and medical decision making of low
							 complexity. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the presenting problem(s) are of
							 moderate to high severity. Physicians typically spend 60 minutes face-to-face
							 with the patient and/or family.
99211
Office or other outpatient visit for the evaluation
							 and management of an established patient, that may not require the presence of
							 a physician. Usually, the presenting problem(s) are minimal. Typically, 5
							 minutes are spent performing or supervising these services.
99212
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: a problem focused history; a problem focused examination;
							 straightforward medical decision making. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the presenting
							 problem(s) are self limited or minor. Physicians typically spend 10 minutes
							 face-to-face with the patient and/or family.
99213
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: an expanded problem focused history; an expanded problem
							 focused examination; medical decision making of low complexity. Counseling
							 and/or coordination of care with other providers or agencies are provided
							 consistent with the nature of the problem(s) and the patient's and/or family's
							 needs. Usually, the presenting problem(s) are of low to moderate severity.
							 Physicians typically spend 15 minutes face-to-face with the patient and/or
							 family.
99214
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: a detailed history; a detailed examination; medical
							 decision making of moderate complexity. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the presenting
							 problem(s) are of moderate to high severity. Physicians typically spend 25
							 minutes face-to-face with the patient and/or family.
99215
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: a comprehensive history; a comprehensive examination;
							 medical decision making of high complexity. Counseling and/or coordination of
							 care with other providers or agencies are provided consistent with the nature
							 of the problem(s) and the patient's and/or family's needs. Usually, the
							 presenting problem(s) are of moderate to high severity. Physicians typically
							 spend 40 minutes face-to-face with the patient and/or family.
99241
Office consultation for a new or established patient,
							 which requires these three key components: a problem focused history; a problem
							 focused examination; and straightforward medical decision making. Counseling
							 and/or coordination of care with other providers or agencies are provided
							 consistent with the nature of the problem(s) and the patient's and/or family'
							 needs. Usually, the presenting problem(s) are self-limited or minor. Physicians
							 typically spend 15 minutes face-to-face with the patient and/or family.
99242
Office consultation for a new or established patient,
							 which requires these three key components: an expanded problem focused history;
							 an expanded problem focused examination; and straightforward medical decision
							 making. Counseling and/or coordination of care with other providers or agencies
							 are provided consistent with the nature of the problem(s) and the patient's
							 and/or family's needs. Usually, the presenting problem(s) are of low severity.
							 Physicians typically spend 30 minutes face-to-face with the patient and/or
							 family.
99243
Office consultation for a new or established patient,
							 which requires these three key components: a detailed history; a detailed
							 examination; and medical decision making of low complexity. Counseling and/or
							 coordination of care with other providers or agencies are provided consistent
							 with the nature of the problem(s) and the patient's and/or family's needs.
							 Usually, the presenting problem(s) are of moderate severity. Physicians
							 typically spend 40 minutes face-to-face with the patient and/or family.
99244
Office consultation for a new or established patient,
							 which requires these three key components: a comprehensive history; a
							 comprehensive examination; and medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family' needs. Usually, the presenting problem(s) are of moderate to high
							 severity. Physicians typically spend 60 minutes face-to-face with the patient
							 and/or family.
99245
Office consultation for a new or established patient,
							 which requires these three key components: a comprehensive history; a
							 comprehensive examination; and medical decision making of high complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the presenting problem(s) are of moderate to high
							 severity. Physicians typically spend 80 minutes face-to-face with the patient
							 and/or family.
99307
Subsequent nursing facility care, per day, for the
							 evaluation and management of a new or established patient, which requires at
							 least two of these three key components: a problem focused interval history; a
							 problem focused examination; medical decision making that is straightforward.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the patient is stable, recovering or improving.
99308
Subsequent nursing facility care, per day, for the
							 evaluation and management of a new or established patient, which requires at
							 least two of these three key components: an expanded problem focused interval
							 history; an expanded problem focused examination; medical decision making of
							 low complexity. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the patient is responding
							 inadequately to therapy or has developed a minor complication.
99309
Subsequent nursing facility care, per day, for the
							 evaluation and management of a new or established patient, which requires at
							 least two of these three key components: a detailed interval history; a
							 detailed examination; medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the patient has developed a significant complication
							 or a significant new problem.
99310
Subsequent nursing facility care, per day, for the
							 evaluation and management of a new or established patient, which requires at
							 least two of these three key components: a comprehensive interval history; a
							 comprehensive examination; medical decision making of high complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. The patient may be unstable or may have developed a significant
							 new problem requiring immediate physician attention.
99324
Domiciliary or rest home visit for the evaluation and
							 management of a new patient which requires these three key components: a
							 problem focused history; a problem focused examination; and straightforward
							 medical decision making. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually, the presenting problem(s) are
							 of low severity. Physicians typically spend 20 minutes with the patient and/or
							 family or caregiver.
99325
Domiciliary or rest home visit for the evaluation and
							 management of a new patient which requires these three key components: an
							 expanded problem focused history; an expanded problem focused examination; and
							 medical decision making of low complexity. Counseling and/or coordination of
							 care with other providers or agencies are provided consistent with the nature
							 of the problem(s) and the patient's and/or family's needs. Usually, the
							 presenting problem(s) are of moderate severity. Physicians typically spend 30
							 minutes with the patient and/or family or caregiver.
99326
Domiciliary or rest home visit for the evaluation and
							 management of a new patient which requires these three key components: a
							 detailed history; a detailed examination; and medical decision making of
							 moderate complexity. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually, the presenting problem(s) are
							 of moderate to high severity. Physicians typically spend 45 minutes with the
							 patient and/or family or caregiver.
99327
Domiciliary or rest home visit for the evaluation and
							 management of a new patient which requires these three key components: a
							 comprehensive history; a comprehensive examination; and medical decision making
							 of moderate complexity. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually, the presenting problem(s) are
							 of high severity. Physicians typically spend 60 minutes with the patient and/or
							 family or caregiver.
99328
Domiciliary or rest home visit for the evaluation and
							 management of a new patient which requires these three key components: a
							 comprehensive history; a comprehensive examination; and medical decision making
							 of high complexity. Counseling and/or coordination of care with other providers
							 or agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the patient is unstable or has
							 developed a significant new problem requiring immediate physician attention.
							 Physicians typically spend 75 minutes with the patient and/or family or
							 caregiver.
99334
Domiciliary or rest home visit for the evaluation and
							 management of an established patient, which requires at least two of these
							 three key components: a problem focused interval history; a problem focused
							 examination; straightforward medical decision making. Counseling and/or
							 coordination of care with other providers or agencies are provided consistent
							 with the nature of the problem(s) and the patient's and/or family's needs.
							 Usually, the presenting problem(s) are self-limited or minor. Physicians
							 typically spend 15 minutes with the patient and/or family or caregiver.
99335
Domiciliary or rest home visit for the evaluation and
							 management of an established patient, which requires at least two of these
							 three key components: an expanded problem focused interval history; an expanded
							 problem focused examination; medical decision making of low complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the presenting problem(s) are of low to moderate
							 severity. Physicians typically spend 25 minutes with the patient and/or family
							 or caregiver.
99336
Domiciliary or rest home visit for the evaluation and
							 management of an established patient, which requires at least two of these
							 three key components: a detailed interval history; a detailed examination;
							 medical decision making of moderate complexity. Counseling and/or coordination
							 of care with other providers or agencies are provided consistent with the
							 nature of the problem(s) and the patient's and/or family's needs. Usually, the
							 presenting problem(s) are of moderate to high severity. Physicians typically
							 spend 40 minutes with the patient and/or family or caregiver.
99337
Domiciliary or rest home visit for the evaluation and
							 management of an established patient, which requires at least two of these
							 three key components: a comprehensive interval history; a comprehensive
							 examination; medical decision making of moderate to high complexity. Counseling
							 and/or coordination of care with other providers or agencies are provided
							 consistent with the nature of the problem(s) and the patient's and/or family's
							 needs. Usually, the presenting problem(s) are of moderate to high severity. The
							 patient may be unstable or may have developed a significant new problem
							 requiring immediate physician attention. Physicians typically spend 60 minutes
							 with the patient and/or family or caregiver.
99341
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: a problem focused history;
							 a problem focused examination; and straightforward medical decision making.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the presenting problem(s) are of low severity.
							 Physicians typically spend 20 minutes face-to-face with the patient and/or
							 family.
99342
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: an expanded problem focused
							 history; an expanded problem focused examination; and medical decision making
							 of low complexity. Counseling and/or coordination of care with other providers
							 or agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the presenting problem(s) are of
							 moderate severity. Physicians typically spend 30 minutes face-to-face with the
							 patient and/or family.
99343
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: a detailed history; a
							 detailed examination; and medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the presenting problem(s) are of moderate to high
							 severity. Physicians typically spend 45 minutes face-to-face with the patient
							 and/or family.
99344
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: a comprehensive history; a
							 comprehensive examination; and medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the presenting problem(s) are of high severity.
							 Physicians typically spend 60 minutes face-to-face with the patient and/or
							 family.
99345
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: a comprehensive history; a
							 comprehensive examination; and medical decision making of high complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the patient is unstable or has developed a significant
							 new problem requiring immediate physician attention. Physicians typically spend
							 75 minutes face-to face with the patient and/or family.
99347
Home visit for the evaluation and management of an
							 established patient, which requires at least two of these three key components:
							 a problem focused interval history; a problem focused examination;
							 straightforward medical decision making. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the presenting
							 problem(s) are self-limited or minor. Physicians typically spend 15 minutes
							 face-to-face with the patient and/or family.
99348
Home visit for the evaluation and management of an
							 established patient, which requires at least two of these three key components:
							 an expanded problem focused interval history; an expanded problem focused
							 examination; medical decision making of low complexity. Counseling and/or
							 coordination of care with other providers or agencies are provided consistent
							 with the nature of the problem(s) and the patient's and/or family's needs.
							 Usually, the presenting problem(s) are of low to moderate severity. Physicians
							 typically spend 25 minutes face-to-face with the patient and/or family.
99349
Home visit for the evaluation and management of an
							 established patient, which requires at least two of these three key components:
							 a detailed interval history; a detailed examination; medical decision making of
							 moderate complexity. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually, the presenting problem(s) are
							 of moderate to high severity. Physicians typically spend 40 minutes
							 face-to-face with the patient and/or family.
99350
Home visit for the evaluation and management of an
							 established patient, which requires at least two of these three key components:
							 a comprehensive interval history; a comprehensive examination; medical decision
							 making of moderate to high complexity. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the presenting
							 problem(s) are of moderate to high severity. The patient may be unstable or may
							 have developed a significant new problem requiring immediate physician
							 attention. Physicians typically spend 60 minutes face-to-face with the patient
							 and/or family.
99354
Prolonged physician service in the office or other
							 outpatient setting requiring direct (face-to-face) patient contact beyond the
							 usual service (e.g., prolonged care and treatment of an acute asthmatic patient
							 in an outpatient setting); first hour. (List separately in addition to code for
							 office or other outpatient Evaluation and Management service).
99355
Each additional 30 minutes. (List separately in
							 addition to code for prolonged physician service).
99499
Other Unlisted Evaluation and Management
							 Services.
0207T
Evacuation of Meibomian glands, automated, using heat
							 and intermittent pressure, unilateral.
A4263
Permanent, long-term, non-dissolvable lacrimal duct
							 implant, each.
G0117
Glaucoma screening for high-risk patients furnished
							 by an optometrist or ophthalmologist.
G0118
Glaucoma screening for high-risk patients furnished
							 under the direct supervision of an optometrist or ophthalmologist.
XXXXX-55
Ophthalmic surgery co-management/postoperative
							 care.
S0500
Disposable contact lens, per lens.
S0504
Single vision prescription lens (safety, athletic, or
							 sunglass), per lens.
S0506
Bifocal vision prescription lens (safety, athletic,
							 or sunglass), per lens.
S0508
Trifocal vision prescription lens (safety, athletic,
							 or sunglass) per lens.
S0510
Non-prescription lens (safety, athletic, or
							 sunglass), per lens.
S0512
Daily wear specialty contact lens, per lens.
S0514
Color contact lens, per lens.
S0516
Safety eyeglass frames.
S0518
Sunglasses frames.
S0580
Polycarbonate lens.
S0581
Nonstandard lens.
S0590
Integral lens service, miscellaneous services
							 reported separately.
S0592
Comprehensive contact lens evaluation.
S0620
Routine ophthalmological examination including
							 refraction; new patient.
S0621
Routine ophthalmological examination including
							 refraction; established patient.
S0820
Computerized corneal topography, unilateral.
S0830
Ultrasound pachymetry to determine corneal thickness,
							 with interpretation and report, unilateral.
Optometric Clinical Procedures Approved by South Dakota
				  Board of Optometry
(these codes require hospital privileges)
CPT Code
Description of Clinical Procedure
Notes/Comments
99221
Initial hospital care, per day, for the evaluation
							 and management of a patient which requires these three key components: a
							 detailed or comprehensive history; a detailed or comprehensive examination; and
							 medical decision making that is straightforward or of low complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problems(s) and the patient's and/or
							 family's needs. Usually, the problems requiring admission are of low severity.
							 Physicians typically spend 30 minutes at the bedside and on the patient's
							 hospital floor or unit.
99222
Initial hospital care, per day, for the evaluation
							 and management of a patient which requires these three key components: a
							 comprehensive history; a comprehensive examination; and medical decision making
							 of moderate complexity. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually, the problems requiring
							 admission are of moderate severity. Physicians typically spend 50 minutes at
							 the bedside and on the patient's hospital floor or unit.
99223
Initial hospital care, per day, for the evaluation
							 and management of a patient which requires these three key components: a
							 comprehensive history; a comprehensive examination; and medical decision making
							 of high complexity. Counseling and/or coordination of care with other providers
							 or agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the problems requiring admission are
							 of high severity. Physicians typically spend 70 minutes at the bedside and on
							 the patient's hospital floor or unit.
99231
Subsequent hospital care, per day, for the evaluation
							 and management of a patient, which requires at least two of these three key
							 components: a problem focused interval history; a problem focused examination;
							 medical decision making that is straightforward or of low complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the patient is stable, recovering or improving.
							 Physicians typically spend 15 minutes at the bedside and on the patient's
							 hospital floor or unit.
99232
Subsequent hospital care, per day, for the evaluation
							 and management of a patient, which requires at least two of these three key
							 components: an expanded problem focused interval history; an expanded problem
							 focused examination; medical decision making of moderate complexity. Counseling
							 and/or coordination of care with other providers or agencies are provided
							 consistent with the nature of the problem(s) and the patient's and/or family's
							 needs. Usually, the patient is responding inadequately to therapy or has
							 developed a minor complication. Physicians typically spend 25 minutes at the
							 bedside and on the patient's hospital floor or unit.
99233
Subsequent hospital care, per day, for the evaluation
							 and management of a patient, which requires at least two of these three key
							 components: a detailed interval history; a detailed examination; medical
							 decision making of high complexity. Counseling and/or coordination of care with
							 other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the patient is
							 unstable or has developed a significant complication or a significant new
							 problem. Physicians typically spend 35 minutes at the bedside and on the
							 patient's hospital floor or unit.
99234
Observation or inpatient hospital care, for the
							 evaluation and management of a patient including admission and discharge on the
							 same date which requires these three key components: a detailed or
							 comprehensive history; a detailed or comprehensive examination; and medical
							 decision making that is straightforward or of low complexity. Counseling and/or
							 coordination of care with other providers or agencies are provided consistent
							 with the nature of the problem(s) and the patient's and/or family's needs.
							 Usually the presenting problem(s) requiring admission are of low
							 severity.
99235
Observation or inpatient hospital care, for the
							 evaluation and management of a patient including admission and discharge on the
							 same date which requires these three key components: a comprehensive history; a
							 comprehensive examination; and medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually the presenting problem(s) requiring admission are of
							 moderate severity.
99238
Hospital discharge day management; 30 minutes or
							 less.
99239
Hospital discharge day management; more than 30
							 minutes.
99251
Initial inpatient consultation for a new or
							 established patient, which requires these three key components: a problem
							 focused history; a problem focused examination; and straightforward medical
							 decision making. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the presenting problem(s) are self
							 limited or minor. Physicians typically spend 20 minutes at the bedside and on
							 the patient's hospital floor or unit.
99252
Initial inpatient consultation for a new or
							 established patient, which requires these three key components: an expanded
							 problem focused history, an expanded problem focused examination, and
							 straightforward medical decision making. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the presenting
							 problem(s) are of low severity. Physicians typically spend 40 minutes at the
							 bedside and on the patient's hospital floor or unit.
99253
Initial inpatient consultation for a new or
							 established patient, which requires these three key components: a detailed
							 history; a detailed examination; and medical decision making of low complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the presenting problem(s) are of moderate severity.
							 Physicians typically spend 55 minutes at the bedside and on the patient's
							 hospital floor or unit.
99254
Initial inpatient consultation for a new or
							 established patient, which requires these three key components: a comprehensive
							 history; a comprehensive examination; and medical decision making of moderate
							 complexity. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the presenting problem(s) are of
							 moderate to high severity. Physicians typically spend 80 minutes at the bedside
							 and on the patient's hospital floor or unit.
99255
Initial inpatient consultation for a new or
							 established patient, which requires these three key components: a comprehensive
							 history; a comprehensive examination; and medical decision making of high
							 complexity. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the presenting problem(s) are of
							 moderate to high severity. Physicians typically spend 110 minutes at the
							 bedside and on the patient's hospital floor or unit.
99281
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components: a problem
							 focused history; a problem focused examination; and straightforward medical
							 decision making. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the presenting problem(s) are self
							 limited or minor.
99282
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components: an expanded
							 problem focused history; an expanded problem focused examination; and medical
							 decision making of low complexity. Counseling and/or coordination of care with
							 other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the presenting
							 problem(s) are of low or moderate severity.
99283
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components: an expanded
							 problem focused history; an expanded problem focused examination; and medical
							 decision making of moderate complexity. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the presenting
							 problem(s) are of moderate severity.
99284
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components: a detailed
							 history; a detailed examination; and medical decision making of moderate
							 complexity. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the presenting problem(s) are of high
							 severity, and require urgent evaluation by the physician but do not pose-an
							 immediate significant threat to life or physiologic function.
99285
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components within the
							 constraints imposed by the urgency of the patient's clinical condition and/or
							 mental status: a comprehensive history; a comprehensive examination; and
							 medical decision making of high complexity. Counseling and/or coordination of
							 care with other providers or agencies are provided consistent with the nature
							 of the problem(s) and the patient's and/or family's needs. Usually, the
							 presenting problem(s) are of high severity, and pose an immediate significant
							 threat to life or physiologic function.
99356
Prolonged physician service in the inpatient setting,
							 requiring direct (face-to-face) patient contact beyond the usual service
							 (e.g.), maernal fetal monitoring for high risk delivery or other physiological
							 monitoring, prolonged care of an acutely ill inpatient), first hour (List
							 separately in addition to code for inpatient Evaluation and Management
							 service).
99357
Each additional 30 minutes (List separately in
							 addition to code for prolonged physician service).