Reimbursement Updates

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Blue Card of Michigan Resolves Payment Errors

November 6, 2017 - Michigan

Blue Card Network of Michigan has announced that an error in its claims processing system incorrectly denied payment for CPT® Code 83861, tear osmolarity test. The error has been corrected and retroactive payment will be made automatically for Medicare Blue Plus product lines that were inappropriately denied. If there are any additional questions, please contact the TearLab Reimbursement Support Center.

McLaren Medicaid Covers Tear Osmolarity

October 30, 2017 - Michigan

McLaren Health Plan of Michigan has announced that CPT® Code 83861, tear osmolarity test, will be a covered service for the Medicaid product lines with an effective date of January 1, 2017. Claims will be retroactively paid from that date. If there are any additional questions, please contact the TearLab Reimbursement Support Center.

Georgia Medicaid Corrects Rate for CPT 83861

June 1, 2017 - Georgia

The Georgia Department of Community Health, Medical Policy Division announced on June 1, 2017 that its payment rate for the tear osmolarity test, CPT 83861, is incorrectly undervalued and an increased rate will be effective for dates of service on or after January 1. 2017. For additional information please contact the TearLab Reimbursement Support Center.

BCBS MN Establishes Coverage for Tear Osmolarity

October 3, 2016 - Minnesota

BCBS of Minnesota has announced that CPT 83861, tear osmolarity test, will be a covered service for Optometrists and Ophthalmologist with an effective date of October 3, 2016. The coverage update impacts the Commercial, Managed Medicaid, and Medicare lines of business within BCBS of Minnesota. If there are any additional questions, please contact the TearLab Reimbursement Support Center.

MVP Expands Coverage to Include Optometry

October 1, 2016 - New York

 MVP Health Care has established coverage for the TearLab osmolarity test, CPT 83861, effective 10/01/16. The medical policy has been updated to allow coverage for Optometrists in addition to Ophthalmologists. If there are any additional questions, please contact the TearLab Reimbursement Support Center.

Priority Health Establishes Medicaid Coverage for Tear Osmolarity

January 1, 2016 - Michigan

Priority Health of Michigan has announced that CPT® Code 83861, tear osmolarity test, will be a covered service for the Medicaid product lines with an effective date of January 1, 2016.  If there are any additional questions, please contact the TearLab Reimbursement Support Center.

UHC Michigan Covers Medicaid Benefits for Tear Osmolarity

November 1, 2015 - Michigan

United Heathcare (UHC) of Michigan has announced that CPT® Code 83861, tear osmolarity test, is a covered service for the Medicaid product line with an effective date of November 1, 2015.  If there are any additional questions, please contact the TearLab Reimbursement Support Center.

BCBS of MN Establishes Medicare Advantage Coverage for 83861

September 1, 2015 - Minnesota

Blue Cross Blue Shield (BCBS) of Minnesota has announced that CPT® 83861, tear osmolarity test, is a covered service for the Medicare Advantage product line with an effective date of September 1, 2015.  If there are any additional questions, please contact the TearLab Reimbursement Support Center.

Triple-S Initiates Coverage for Tear Osmolarity

August 1, 2015 - Puerto Rico

Triple-S (SSS) a provider of Medicare Managed Care in Puerto Rico has announced that effective August 2015 they will initiate coverage for CPT® 83861 (tear osmolarity).  Claims should be coded and filed in the same manner as CMS Medicare.  For more information, contact the TearLab Reimbursement Support Center.

KanCare Medicaid Covers Tear Osmolarity Test

May 1, 2015 - Kansas

KanCare of Kansas has announced that CPT 83861, tear osmolarity test, will cover services for Optometrist and Ophthalmology with an effective date of May 1, 2015. The coverage update impacts Medicaid. KanCare has contracts with three managed care organizations (MCOs) who coordinate care for members, Amerigroup of Kansas, Sunflower State Health Plan, and United HealthCare Community Plan of Kansas. If there are any additional questions, please contact the TearLab Reimbursement Support Center.

Cigna Adds CPT 83861 to National Fee Schedule

January 1, 2015 - Nationwide

Cigna has confirmed that effective as of January 1, 2015 CPT® 83861 (tear osmolarity test) has been added to its national fee schedule.  Provider contract updates may be required for providers to receive payment for this service.  Please contact the TearLab Reimbursement Support Center for assistance with these updates. 

MainCare Establishes Reimbursement for Tear Osmolarity Test

January 1, 2015 - Maine

MaineCare has confirmed coverage for laboratory providers and vision providers.  Contact TearLab Reimbursement Support Center for details and fee schedule information.

Priority Health Announces Tear Osmolarity Coverage For Optometry

November 14, 2014 - Michigan

Priority Health of Michigan has announced that CPT 83861, tear osmolarity test, will be a covered service for Optometrists with an effective date of January 1, 2015. The coverage update impacts the Commercial and Medicare lines of business. If there are any additional questions, please contact the TearLab Reimbursement Support Center.                        

Capital Health Plan Initiates Coverage For Tear Osmolarity Test

November 3, 2014 - Florida

Capital Health Plan has announced coverage for the tear osmolarity test, CPT 83861.  Providers of Capital Health Plan will need to submit a request to add CPT 83861 to their existing contract. Contact the TearLab Reimbursement Support Center for additional information and assistance.

Florida Medicaid Covers Tear Osmolarity For Optometry

October 22, 2014 - Florida

Effective January 2015, Florida Medicaid has announced that CPT 83861, tear osmolarity, will be added to the fee schedule for Optometrists. If there are additional questions, please contact TearLab for additional information.

Coventry Of Georgia Initiates Coverage For Tear Osmolarity Test

October 1, 2014 - Georgia

Coventry of Georgia has initiated coverage for the tear osmolarity test, CPT 83861.  Providers of Coventry of Georgia will need to request an amendment to add CPT 83861 to their existing contract.  Contact TearLab Reimbursement Support Center for additional information and assistance.

Indiana Medicaid Covers Tear Osmolarity For Optometry

July 31, 2014 - Indiana

Effective immediately, Indiana Medicaid has announced that CPT 83861, tear osmolarity, has been added to the fee schedule for Optometrists with retroactive coverage. Providers may receive payment retroactively as long as the claim is not outside the 1 year timely filing limit from date of service. If there are additional questions, please contact TearLab for additional information.

BCBS Of MA To Cover ODs For Tear Osmolarity

July 29, 2014 - Massachusetts

BCBS of Massachusetts has announced that CPT 83861, tear osmolarity test, will be a covered service for Optometrists with an effective date of September 1, 2014. The coverage update impacts the Commercial, Managed Medicaid, and Medicare lines of business within BCBS of Massachusetts. If there are any additional questions, please contact the TearLab Reimbursement Support Center.

Advocate Health Covers Tear Osmolarity Test

May 15, 2014 – Chicago and Central IL

Advocate Health with Advocate Physician Partners (APP), a care management collaboration, has announced that CPT 83861, tear osmolarity, has been added to the fee schedule for Optometrists and Ophthalmologists with retroactive coverage starting from 10/1/2013. All previously denied claims with date of service on or after 10/1/2013 will automatically be re-processed by Advocate Health and paid. Plans offered include Commercial and Medicare HMO whom APP has benefits for members. For additional questions or information, please contact TearLab Reimbursement Support Center at rsc@tearlab.com.

MCS Covers Tear Osmolarity Testing

April 31, 2014- Puerto Rico

Medical Card System (MCS) a provider of Managed Care, Medicare and Commercial Plans in Puerto Rico has announced that effective April 1, 2014 they will initiate coverage for CPT 83861 (tear osmolarity).  Claims should be coded and filed in the same manner as CMS Medicare. For more information, contact the TearLab Reimbursement Support Center.

Presence Health Partners Covers CPT 83861

April 28, 2014- Illinois

Presence Health, the largest Catholic health system based in Illinois, a combination of St. Mary’s and St. Elizabeth network, has announced coverage for CPT 83861, tear osmolarity, effective September 1, 2013. Claims with a date of service on or after this date have been adjudicated and paid. No in office lab list is required for coverage.

Health Partners Plans Now Covering Tear Osmolarity Test

April 15, 2014 – Philadelphia, PA

Health Partners Plans, a Philadelphia area Managed Care Organization, has announced that CPT 83861, tear osmolarity, has been added to the fee schedule for Optometrists and Ophthalmologists with coverage starting from 4/1/2014. Health Partners Plans offers Managed Medicaid, CHiP, and Medicare Advantage benefits for members within Philadelphia and its surrounding counties. If there are additional questions, please contact TearLab for additional information.

QualCare Inc. Now Covers Tear Osmolarity Testing

April 10, 2014 – New Jersey

QualCare Inc., a New Jersey managed care plan is now covering CPT 83861, Tear Osmolarity within its Commercial and Medicare benefits. In order to receive payment, QualCare Inc. has advised all in-network providers to contact their Provider Relations Representative to update their contract to allow for in-office laboratory testing. If there are different contracts to cover multiple benefits, each contract would need updating. It is encouraged that when contacting Provider Relations to have all necessary CLIA information available. If there are additional questions, please contact TearLab for additional information.

Coventry Of The Carolinas Adds Tear Osmolarity Coverage

March 24, 2014 - North and South Carolina

Coventry of the Carolinas, serving over 187,000 North and South Carolina residents, has advised that effective April 1, 2014, CPT 83861, tear osmolarity, will be added to the in-office lab list, allowing coverage when the test is performed in an ophthalmology or optometry office.

Important Reimbursement Update – CPT 83861 – Tear Osmolarity CMS Medicare Claims – Referring Physician NPI

Effective January 6, 2014, CMS will no longer accept a Group NPI number as the Referring Physician identification (item 17 on the CMS-1500 form) for claims for laboratory services, including tear osmolarity (CPT 83861).  This requirement applies only to the Referring/Ordering provider identification.  Payments may still be made to group or organizational NPI numbers.

For details please see MLN Matters Number SE1305 Revised - MLN Matters SE1305

For all claims for a tear osmolarity test, enter the name and NPI for the ordering/referring provider, not the group NPI, in item 17 of paper claims (CMS-1500).  Name and NPI number must match.  Only include the first and last name as it appears on the “Ordering and Referral File” found here: Ordering & Referring Information CMS.gov

For electronic claims, make sure that the qualifier (X12N 837P 4010A1) 2310A NM102 loop is a 1 (person). Organizations (qualifier 2) cannot order and refer.

Please note that CPT 83861 (tear osmolarity) remains a covered service for CMS Medicare and reimburses under the CMS Clinical Laboratory Fee Schedule at $22.54 per test in 2014 which can be found on here: 14CLAB 

If you have any denials for CMS Medicare claims or need additional assistance in this matter, please contact the TearLab Reimbursement Support Center at 855-TEARLAB (1-855-832-7522), Option 1, then Option 4 or email us at rsc@tearlab.com.

BlueChoice HealthPlan Of SC Adds 83861 To In-Office Lab List

February 14, 2014 - South Carolina

BlueCross BlueShield of South Carolina announced that tear osmolarity testing (CPT 83861) will now be covered when performed in a physician office for BlueChoice HealthPlan patients. Coverage will be effective from 1/1/2014.

Optima Health Adds CPT 83861 To In-Office Lab List

February 7, 2014 - Virginia

Optima Health Plan, also known as Sentara Health Plans, has advised that the tear osmolarity test, CPT 83861, will be added to its approved in-office laboratory test list, allowing coverage for patients tested at their doctor's office. The effective date of coverage to be announced.

United HealthCare CO Adds 83861 To Capitated MA Plans
January 21, 2014 - Colorado
United HealthCare (UHC) of Colorado has advised that physicians may bill and receive payment for the tear osmolarity test, CPT 83861, performed on Medicare Advantage (MA) patients who are under capitation agreements.  Payment will be effective for date of service on or after October 1, 2013.  UHC has indicated that it is possible that the provider may be paid for prior dates of service based on provider agreement reconsideration provisions.
Independence Blue Cross Announces Coverage For Tear Osmolarity

December 23,  2013 - Pennsylvania, New Jersey Delaware

Independence Blue Cross has notified the American Optometric Association and the Pennsylvania Medical Society that the tear osmolarity test, CPT 83861, will be reimbursed for optometry or ophthalmology beginning with dates of service on or after February 1, 2014. 

CDPHP Announces System Updated To Process 83861

December 3, 2013 - New York

Capital District Physicians' Health Plan (CDPHP) which has covered the tear osmolarity test effective January 1, 2013, has today advised that its system has now been updated to accept claims for CPT 83861.  All new claims should be paid automatically when submitted.  Contact TearLab Reimbursement Support Center for advice on obtaining payment for previously submitted denied claims.

UHC Oxford Adds Tear Osmolarity To In-Office Lab List

November 25, 2013 - New York

United HealthCare Oxford, covering the greater NYC metropolitan area, has announced that CPT 83861 (tear osmolarity) will be added to its allowed in-office laboratory list, with coverage for physician office laboratories effective December 1, 2013.  Note that UHC Oxford requires tear osmolarity to be billed with 83861 as one line item for 2-units of service, use no modifiers, when testing both eyes.

BCBS AL Adds 83861 To Allowed In-Office And Optometry Fee Schedules

November 22, 2013 - Alabama

Blue Cross Blue Shield of Alabama has advised that the tear osmolarity test (CPT 83861) will be added to the allowed in-office laboratory list and to the Preferred Optometry fee schedule, with coverage retroactive to January 10, 2013.  BCBS AL will need to incorporate some changes to their system before coverage can be initiated, but all affected claims will be internally reprocessed.  Contact TearLab's Reimbursement Support Center for additional information.

BCBS GA - Tear Osmolarity To Match Medicare Fee Schedule

November 21, 2013

Blue Cross Blue Shield of Georgia, whose laboratory fee schedule has been paying CPT 83861 (tear osmolarity) below the cost to perform the test, has agreed to match Medicare's CMS Clinical Laboratory Fee Schedule.  CMS had previously accepted a formal cost analysis that accurately reimburses the doctor for the resources necessary to perform the in-office tear osmolarity test.  For more information visit the CMS website at CMS Laboratory Fee Schedule.

Scott & White Initiates Coverage For Tear Osmolarity Test

November 18, 2013 - Texas

Scott & White Health Plan has announced coverage for the tear osmolarity test, CPT 83861.  Providers of Scott & White will need to submit an amendment to add CPT 83861 to their existing contract.  Contact TearLab Reimbursement Support Center for additional information and assistance.

Blue Shield Of NENY Initiates Coverage For Tear Osmolarity

October 30, 2013 - New York

Director of Provider Support at Blue Shield of Northeast New York has advised the American Optometric Association, Third Party Center, that the tear osmolarity test, CPT 83861, will be reimbursed when billed by an optometrist or ophthalmologist and will be paid separately from an office visit or eye examination.

BCBS Of Western NY To Cover CPT 83861 Separate From An Office Visit

October 30, 2013 - New York

Director of Provider Support at BCBS of Western New York has advised the American Optometric Association, Third Party Center, that the tear osmolarity test, CPT 83861, will be reimbursed when billed by an optometrist or ophthalmologist and will be paid separately from an office visit or eye examination.  

Emblem Health - System UpDate Delay - Coverage Assured
September 10, 2013 - New York

The Physician & Contracting Management department, at Emblem Health confirmed that the tear osmolarity test, CPT 83861, is a covered service and will be reimbursed. Some claims are being denied because Emblem Health has not entered this code into their system. Although an exact date of system implementation was not provided, it was recommended that providers continue to submit claims for 83861. If claims are denied, once a month or once a quarter they should submit a spread sheet of the denied claims to their Emblem Health provider representative for manual processing and payment. Claims will be paid retroactive to November 1, 2012 when Emblem Health initiated coverage for CPT 83861. For additional information or assistance please contact your Emblem Health provider representative or the TearLab Reimbursement Support Center.

Brown & Toland Allows Tear Osmolarity Testing

September 1, 2013 - California

Brown & Toland Physicians, an independent practice association (IPA) of more than 850 community physicians serving 300,000 San Francisco Bay Area residents, has agreed, effective September 1, 2013, to allow tear osmolarity testing, CPT 83861, to be performed at the doctor's office. Prior to this laboratory testing was capitated to LabCorp and tear osmolarity was not allowed at the doctors office.

HealthPlus Of MI Adds Tear Osmolarity To System

August 21, 2013 - Michigan

HealthPlus of Michigan has advised that CPT 83861 (tear osmolarity) has been added to its system as a covered code to automatically pay submitted claims. Prior to this a Special Office Procedure (SOP) request form needed to be submitted for payment for tear osmolarity tests. The SOP form will no longer be required.

OH Medicaid Adds CLIA Waived Coverage For Tear Osmolarity

August 1, 2013 - Ohio

The Ohio Department of Medicaid announced that CPT 83861 (tear osmolarity) will be added to its approved CLIA Waived test list. It is expected that their payment system will be upgraded with the change in the next 30-days, and the change will be retroactive. Doctors with a CLIA Waiver certificate who have been denied payment for the tear osmolarity test (CPT 83861) can resubmit their claims which will be paid retroactively.

UHA Adds Tear Osmolarity To Optometry

July 17, 2013 - Hawaii

UHA, formally known as University Health Alliance, in Hawaii has announced that it will add the tear osmolarity test (CPT 83861) to optometry vision contracts, effective immediately. Previously, UHA was providing coverage to ophthalmology, but declining coverage to optometry.   Coverage was added to optometry contracts due to Hawaiian scope of practice provisions which allows diagnosis and treatment of dry eye disease.

BCBS NC - Tear Osmolarity To Match Medicare Fee Schedule

July 15, 2013 - North Carolina

Blue Cross Blue Shield of North Carolina, whose laboratory fee schedule has been paying CPT 83861 (tear osmolarity) below the cost to perform the test, has agreed to re-contract NC providers to reflect new pricing methodology that will match Medicare's CMS Clinical Laboratory Fee Schedule.  CMS had previously accepted a formal cost analysis that accurately reimburses the doctor for the resources necessary to perform the in-office tear osmolarity test.  For more information visit the CMS website at CMS Laboratory Fee Schedule

BCBS FL Adds Tear Osmolarity To In-Office Lab List

July 1, 2013 - Florida

Blue Cross Blue Shield of Florida, covering over 2.6 million lives in the State of Florida, has added the tear osmolarity test, CPT 83861, to its allowed In-Office Laboratory Services.  A list of laboratory tests allowed in-office can be found on the BCBS FL website. Tests on this list are the only laboratory services eligible for payment when performed in the office by a participating BCBS FL or Health Options physician. Coverage is effective July 1, 2013, and will not pay for date of service prior to this date.

BCBS MI Approves Tear Osmolarity Test
June 21, 2013 - Michigan

Blue Cross Blue Shield of Michigan has advised that its Medical Policy Committee has reversed its position that the tear osmolarity test (CPT 83861) is an "investigational / experimental" procedure. BCBS MI advises that its medical policy will be revised to reflect the medical criteria for coverage of the procedure, a process that will take approximately 90 days. Coverage will begin with dates of service after the effective date of the policy change. Claims for 83861 will not be covered during the transitional phase.

Illinois Medicaid Covers Tear Osmolarity Test

May 30, 2013 - Illinois

The Illinois Department of Public Aid (Medicaid) has agreed to establish coverage for the tear osmolarity test, CPT 83861,  when performed in a CLIA certified physicians office.

UPMC To Cover Optometry For Tear Osmolarity Test

May 29, 2013 - Pennsylvania

After reviewing the optometry scope of practice in Pennsylvania, the University of Pittsburgh Medical Center health plan has announced that it will add CPT 83861, tear osmolarity testing, to the optometry fee schedule.  This will eliminate the need for optometrists to revise their provider contract to include coverage of this in-office laboratory test.  UPMC had previously added CPT 83861 to the ophthalmology fee schedule.

PHP Adds Tear Osmolarity To In-Office Lab List

April 2, 2013 - Michigan

Physicians Health Plan of Mid-Michigan has added the tear osmolarity test (CPT 83861) to the in-office laboratory list, allowing the test to be performed at the doctor's office.  Outstanding claims that have not been paid can be faxed to the attention of Trisha Kopulos at (517) 364-8412  for payment. 

BCBS KC Adds Tear Osmolarity Test To HMO Plans

April 1, 2013 - Missouri

Blue Cross Blue Shield of Kansas City has advised that CPT 83861 has been added to the in-office laboratory list for HMO plans effective 4/1/13.  Previously denied claims should be resubmitted for payment as an "inquiry".

BCBS MI Medicare Advantage Adds Tear Osmolarity To In-Office Lab List

March 25, 2013 - Michigan

The Blue Cross Blue Shield of Michigan Medicare Advantage program has advised that tear osmolarity, CPT 83861, will be added to its in-office laboratory list, extending coverage to ophthalmologists and optometrists that perform the test at the point of care.  Prior to this, testing had to be performed at a Joint Venture Hospital Laboratory. BCBS MI has advised that the estimated completion date for this extension will be 4/24/13 and claims previously denied will be paid retroactively.  Providers will not have to re-bill.  Going forward, claims should be billed with a QW modifier when performed by a CLIA Waived physician office laboratory.
Presbyterian Health Initiates Coverage For Tear Osmolarity Testing

March 14, 2013 - New Mexico

Presbyterian Health Plan in New Mexico has advised that coverage will begin for the Tear Osmolarity test, CPT 83861.  Providers who wish to perform the test should contact the Network Contract Manager to amend their provider contract to allow in-office testing.  Contact TearLab for additional information.
Anthem BCBS VA Adds Tear Osmolarity To HMO Products

March 7, 2013 - Virginia

Anthem Blue Cross Blue Shield of Virginia has announced that CTP 83861 (tear osmolarity) has been added to the allowed Physician Office Laboratory (POL) list of services that will now be covered under its HMO plans, HealthKeepers (HMO) and HealthKeepers Plus (HK+ Medicaid). Coverage is effective retroactive to 11/15/2012.
Florida Medicaid To Cover Tear Osmolarity Test

March 7, 2013 - Florida

The Bureau of Medicaid Services in Florida today announced that effective July 1, 2013, CPT 83861, tear osmolarity, will be added to the physician fee schedule for tests performed on Medicaid patients at the doctor's office.
WellPoint Adds 83861 Tear Osmolarity To POL List

March 7, 2013 - Nationwide

WellPoint, Inc. the largest managed health care, for-profit company in the Blue Cross and Blue Shield Association - representing 29 million members, has added tear osmolarity (CPT 83861) to its Physician Office Laboratory (POL) list of services throughout its nationwide network, allowing the test to be performed at the doctor's office.
Coventry HealthAmerica Approves Coverage For Tear Osmolarity Test At Doctor Office

February 14, 2013 - Pennsylvania

Health America of Pennsylvania, a Coventry Health plan, has agreed to initiate coverage for CLIA certified doctor's offices. Provider contracts will be updated to allow coverage for CPT 83861. Requests for contract updates will be made with the provider relations representative. Contact TearLab for details and assistance.
Anthem BCBS VA Adds Optometry For CPT 83861

January 17, 2013 - Virginia

Anthem BCBS VA, a WellPoint health plan, has announced that effective January 17, 2013, the specialty of optometry will be added as a covered provider specialty for the tear osmolarity test for its Par/PPO policies. Its HealthKeepers (HMO) and HealthKeepers+ (Medicaid) policies will require pre-authorization for an out-of-network laboratory service.

BCBS AL Covers CPT 83861 Tear Osmolarity

January 10, 2013 - Alabama

Blue Cross and BlueShield of Alabama has announced that effective January 10, 2013, its non-coverage policy for the tear osmolarity test (CPT 83861) has been reversed and will begin coverage for this test.

Empire BCBS Adds Tear Osmolarity Test To In-Office Laboratory List

January 1, 2013 - New York

Empire Blue Cross Blue Shield, a WellPoint health plan, has announced that the Physician Office Committee has added the tear osmolarity test (CPT 83861) to the allowed physician in-office laboratory list. Coverage for the test will be effective January 1, 2013.

BCBS KS Confirms Coverage For Tear Osmolarity Test

December 28, 2012 - Kansas

BCBS of Kansas has confirmed coverage for CPT 83861, tear osmolarity test, when medically necessary.  In order to obtain payment for both eyes, provider relations has advised that CPT 83861 should be billed only once per claim with no modifiers but for 2-units of service when testing both eyes.

Horizon Blue Extends Coverage To Eye Care Practitioners

December 13, 2012 - New Jersey

Horizon BCBS of New Jersey, covering 1,736,292 members, has advised that based on a Medical Policy review, they will immediately begin coverage for the tear osmolarity test, CPT 83861, when performed by ophthalmologists and optometrists. Previously, coverage for this tear fluid laboratory test was only covered when performed by a pathologist, independent laboratory, multi-physician group or osteopath.
CDPHP Adds Tear Osmolarity To The Office Based Lab List

December 13, 2012 - New York

Capital District Physicians' Health Plan (CDPHP) has advised that effective January 1, 2013, the tear osmolarity test, CPT 83861, will be added to the allowed office based laboratory list as a covered test when performed in physician offices. This reverses a policy that required the test to be performed at contracted participating reference laboratories.
BlueShield Of NE NY Adds Tear Osmolarity To In-Office Lab List

December 4, 2012 - New York

BlueShield of Northeastern New York has advised that the tear osmolarity test, CPT 83861, will be added to its laboratory exempt list, which will allow testing to be performed at the physician office. Prior to this, coverage was limited to testing performed at participating laboratories, which excluded physician office laboratories, and as a result denied patient access to the test as tear samples are too fragile to be collected and sent to an outside reference laboratory for analysis. Provider relations has advised that the system update to include 83861 to the lab exempt list can take up to 30 days to complete.
Trilogy Health Insurance Covers Tear Osmolarity Test

October 24, 2012 - Wisconsin

Trilogy Health Insurance has reversed its non-coverage policy for the tear osmolarity test (CPT 83861) and has announced that it will begin coverage of this test, recommended in the American Academy of Ophthalmology Preferred Practice Pattern guidelines for dry eye disease, for all of its members.
GHI Emblem To Cover CPT 83861 Tear Osmolarity

October 22, 2012 - New York and Nationwide

Upon review of current peer-reviewed published literature and clinical guidelines, the EmblemHealth Medical Policy Subcommittee has reversed its designation of "experimental" for the tear osmolarity test (CPT 83861) and approved coverage, effective November 1, 2012.

HIP Emblem To Cover CPT 83861 Tear Osmolarity

October 22, 2012 - New York

HIP Health Plan of New York, an EmblemHealth company, has reversed its designation of "experimental" for the tear osmolarity test (CPT 83861) and approved coverage, effective November 1, 2012.

HFHP Adds CPT 83861 To Allowed In-Office Lab List

October 15, 2012 - Florida

Health First Health Plans has added the tear osmolarity test to its limited list of allowed in-office laboratory tests, and has removed its pre-authorization requirement. In addition, HFHP has agreed to reprocess claims previously denied for payment when billed by a participating ophthalmologist.
Gateway Medicare Assured Adds Optometry To Fee Schedule

October 1, 2012 - Pennsylvania

Gateway Health Plan has agreed to add the specialty of optometry to its Part C Medicare Advantage plan fee schedule for coverage of CPT 83861, tear osmolarity test. This is a reversal of a prior non-coverage policy for optometry. Coverage for optometrists is effective October 1, 2012, and will be paid in accordance with the CMS Clinical Laboratory Fee Schedule.
BCBS AR To Cover Optometry

September 18, 2012 - Arkansas

A BCBS AR Corporate Medical Director has agreed that the tear osmolarity test should be covered when performed by an optometrist effective immediately.  This is a reversal of a prior non-coverage policy for optometry.  Both optometrists and ophthalmologists in Arkansas can now bill BCBS for the TearLab tear osmolarity test and should code 83861-RT and 83861-LT for payment when testing both eyes.
Geisinger Health Plan To Cover CPT 83861

August 1, 2012 - Pennsylvania

The Geisinger Health Plan has agreed to add the tear osmolarity test to providers contracts as a covered service when performed at the doctors office. Procedure code 83861 will be covered under Geisinger Health Gold, HMO and PPO plans. Providers must request the addition of this code on a case by case basis. Contact the TearLab Reimbursement Center for additional information and assistance in this regard.
WPS Medicare Adds Tear Osmolarity Testing To Optometry Services

July 26, 2012 - KS, MO, NE, IA, MN, WI, IL, MI, IN

WPS Medicare has announced the addition of CPT 83861 (tear osmolarity) as payable for all optometrists effective retroactive to 5/1/12.  The revised policies can be found on the WPS website at the following links:

MN, WI, IL (Legacy Part B):  http://www.wpsmedicare.com/part_b/policy/updates/revised/WPS Medicare will pay optometrists for CPT 83861 under the CMS Clinical Laboratory Fee Schedule, with no patient co-pay or deductible.
Blue Cross Of CA Covers Tear Osmolarity Test To Optometry

July 1, 2012 - California

Pursuant to the addition of CPT 83861 (tear osmolarity) to the VSP fee schedule, Blue Cross of California has confirmed coverage of this test when performed by an optometry office for the management and diagnosis of dry eye disease.  This is in addition to coverage already in place when performed by an ophthalmologist.
VSP Announces: Tear Osmolarity Test Added To Primary Eyecare Plan

June 18, 2012 - Nationwide

VSP today announced that coverage for CPT 83861, an in-office test for diagnosing dry eye disease, will be available on July 1, 2012.  CPT 83861 utilizes the TearLab® Osmolarity System to measure the osmolarity of human tears to aid in the diagnosis of dry eye disease in patients. This lab-on-a-chip technology helps improve standard of care by objectively and quantitatively testing for disease markers in tears at the point of care.  For a current list of Primary EyeCare covered codes and service requirements, refer to the Primary EyeCare Plan under Plans & Coverages in the Manuals section.

BCBS KC Considers Tear Osmolarity Medically Necessary

June 11, 2012 - Missouri

After review of clinical documentation supporting the clinical utility of the tear osmolarity test in the management of dry eye disease, a Blue Cross Blue Shield of Kansas City medical director has advised that their non-coverage policy has been reversed and that the tear osmolarity test is now considered to be medically necessary. 
WPS Medicare To Include Optometry In Tear Osmolarity Testing

May 25, 2012 - Minnesota

It was reported at the WPS May 2012 Carrier Advisory Committee (CAC) meeting, that tear osmolarity testing (CPT code 83861) an allowed service for ophthalmology under its Local Coverage Determination policy will now also include Optometry.  It was stated that coverage will be effective as of May 1, 2012 in all states where WPS is the Medicare carrier, including IA, KS, MO, NE, MN, WI, IL and MI . Please note that this is not official until the coverage policy is updated on the WPS website. We will post a reimbursement update once the official notice is in effect.

Priority Health Of Michigan Confirms Coverage For Tear Osmolarity Test

May 10, 2012 – Michigan

Priority Health has confirmed that it has added both ophthalmology and optometry as specialties that qualify for coverage for tear osmolarity tests performed in doctor’s offices for the diagnosis and management of dry eye disease.  

1199 SEIU National Benefit Fund Adds Tear Osmolarity Testing To The Allowed In-Office Laboratory List.

April 18, 2012 – New York

After review of the clinical guidelines for dry eye disease and documentation demonstrating that tear osmolarity testing can only be performed at the point-of-care, CPT 83861 will be added to the list of laboratory tests that are allowed to be performed at the doctor’s office.   

Blue Cross Blue Shield Carrier In Illinois, Texas, Oklahoma And New Mexico Has Reversed Its Non - Coverage Policy On The Tear Osmolarity Test For Dry Eye Disease.

April 15, 2012 – IL, TX, OK, NM

Health Care Service Corporation, the BCBS carrier for 4-states has advised that after further review by its medical policy team, it has reversed its original assessment that tear osmolarity is an “experimental/investigational procedure” and has determined that tear osmolarity is an appropriate dry eye test and intervention for the improvement of patients lives and will begin coverage effective April 15, 2012.

Priority Health Of Michigan Adds CPT 83861 To Its Allowed In-Office Laboratory List.

April 14, 2012 – Michigan

Priority Health will reimburse participating providers for 83861,“Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity", when performed in provider office laboratories if the results are needed immediately for clinical decisions.  This test is limited to tests performed by specialist physicians with a CLIA license.  

UPMC Technology Assessment Approves Coverage For Tear Osmolarity Test.

April 12, 2012 – Pennsylvania 

University of Pittsburgh Medical Center Health Plan has reviewed documentation supporting the clinical necessity of the tear osmolarity test and has agreed to cover the test. Providers must contact UPMC to update their provider contract to include coverage.  Contact TearLab Corporation for additional information. 

Blue Cross Blue Shield Carrier In Hawaii Approves Coverage For Tear Osmolarity Test.

March 26, 2012 – Hawaii

Hawaii Medical Service Association (BCBS of HI) has approved coverage for CPT 83861 tear osmolarity test.  

Coventry Group Health Care Of Kansas Adds CPT 83861 To Its List Of Allowed In-Office Laboratory Tests.

March 16, 2012 – Kansas

After review of clinical and utilization documentation, including the American Academy of Ophthalmology Preferred Practice Patterns for Dry Eye Syndrome, Coventry Kansas has included CPT 83861 to its in-office laboratory tests, retroactive to January 1, 2012. 

Cigna To Include Tear Osmolarity Testing Under Doctor's Contracted Services.

March 15, 2012 – Virginia

After appeal by a TearLab customer for a claim not payable under the providers contract, Cigna has agreed to add CPT 83861 as allowable testing under the contract effective March 15, 2012.  

Coventry Group Health Care Of Missouri Announces New Code Added To In-Office Lab List. (Network Connections)

March 12, 2012 - Missouri

Coventry Health Care has added 83861 (Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity) to the list of lab codes that can be performed in the physician's office.   

Care First Blue Choice To Cover Tear Osmolarity Testing When Performed In The Doctor's Office.

March 9, 2012 – Maryland

After submission of documentation by TearLab customers to support the need to perform tear osmolarity testing at the point-of-care, Care First Blue Choice announced that CPT 83861 would be added to its allowed in-office lab list effective March 9, 2012.  

Highmark BCBS Reverses Non-Payment Policy To ODs For TearLab Testing.

February 13, 2012 – Pennsylvania

Through intercession by Pennsylvania Optometric Association, Highmark Blue Shield has recently reversed its non-coverage policy for the tear osmolarity test, CPT 83861, when performed by an optometrist using the TearLab Osmolarity System.  

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