[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR410.23]

[Page 330-331]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 410_SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS--Table of 
Contents
 
               Subpart B_Medical and Other Health Services
 
Sec.  410.23  Screening for glaucoma: Conditions for and limitations 
on coverage.

    (a) Definitions: As used in this section, the following definitions 
apply:
    (1) Direct supervision in the office setting means the optometrist 
or the ophthalmologist must be present in the office suite and be 
immediately available to furnish assistance and direction throughout the 
performance of the procedure. It does not mean the physician must be 
present in the room when the procedure is performed.
    (2) Eligible beneficiary means individuals in the following high 
risk categories:
    (i) Individual with diabetes mellitus.
    (ii) Individual with a family history of glaucoma.
    (iii) African-Americans age 50 and over.
    (iv) Hispanic-Americans age 65 and over.
    (3) Screening for glaucoma means the following procedures furnished 
to an individual for the early detection of glaucoma:
    (i) A dilated eye examination with an intraocular pressure 
measurement.
    (ii) A direct ophthalmoscopy examination, or a slit-lamp 
biomicroscopic examination.
    (b) Condition for coverage of screening for glaucoma. Medicare Part 
B pays for

[[Page 331]]

glaucoma screening examinations provided to eligible beneficiaries as 
described in paragraph (a)(2) of this section if they are furnished by 
or under the direct supervision in the office setting of an optometrist 
or ophthalmologist who is legally authorized to perform these services 
under State law (or the State regulatory mechanism provided by State 
law) of the State in which the services are furnished, as would 
otherwise be covered if furnished by a physician or incident to a 
physician's professional service.
    (c) Limitations on coverage of glaucoma screening examinations. (1) 
Payment may not be made for a glaucoma screening examination that is 
performed for an individual who is not an eligible beneficiary as 
described in paragraph (a)(2) of this section.
    (2) Payment may be made for a glaucoma screening examination that is 
performed on an individual who is an eligible beneficiary as described 
in paragraph (a)(2) of this section, after at least 11 months have 
passed following the month in which the last glaucoma screening 
examination was performed.

[66 FR 55328, Nov. 1, 2001, as amended at 70 FR 70330, Nov. 21, 2005]