Recover 50% Revenue Loss

An optometry practice recently added Transcranial Doppler Ultrasound (TCD) to better evaluate blood flow abnormalities in the brain that may affect ophthalmic arteries and vision. The practice billed TCD services for both commercial insurance plans and Medicare beneficiaries.

Because TCD includes both the technical component, with the machine located in-office, and the professional component, with interpretation completed by an outside authorized provider, correct coding is essential. This became especially critical with the new TCD billing rules introduced by CMS in 2025.

Background

In 2025, the practice billed the same TCD codes for all patients, regardless of payer. Commercial insurance plans reimbursed the services without issue. However, Medicare implemented updated TCD coding rules and CPT guidance in 2025.

Although the CMS website lists multiple TCD-related CPT codes, many of these codes do not yet have an allowable reimbursement amount assigned. This created confusion for providers billing Medicare under the new rules.

The Challenges

The practice billed the following CPT codes for all TCD patients:

• 93886 – Complete Transcranial Doppler study
• +93896 – Vasoreactivity study add-on
• +93897 – Emboli detection add-on

Commercial payer reimbursement was consistent:

• 93886: approximately $130+
• +93896: approximately $200+
• +93897: approximately $145+

However, Medicare only reimbursed one of the submitted codes and denied the remaining add-on codes with the message:

“Not billable by this specialty.”

Medicare reimbursement in 2025:

• 93886: $189.65
• 93896: $0
• 93897: $0

As a result, nearly 50% of Medicare TCD revenue was lost. The TCD vendor even advised the provider to write off the unpaid codes.

FC Billing Strategy

FC Billing did not accept the recommendation to write off the denied services. Instead, we initiated a focused compliance and research process.

We continued researching Medicare policy changes, reviewed CMS guidance in detail, verified coverage rules, and contacted CMS directly for clarification. Our goal was to identify a billing pathway that was fully compliant while preserving reimbursement for the practice.

Through this process, we identified a Medicare-approved add-on code that optometrists are permitted to bill in conjunction with the primary TCD code.

After identifying the correct billing structure, FC Billing submitted a test claim using:

• Primary code: 93886
• Correct Medicare-allowed add-on code

Medicare accepted the test claim and issued an additional payment of $98.38, confirming that the revised billing approach was compliant and payable.

Once validated, we moved forward with correcting prior claims.

Results

• Identified a compliant Medicare-approved billing solution
• Submitted 82 Medicare TCD claims for reprocessing for 2025
• Payments are already being issued
• Expected recovered revenue of approximately $8,000 by the end of December 2025

Outcome

• ✔ Preserved Medicare TCD reimbursement
• ✔ Avoided unnecessary write-offs
• ✔ Ensured correct, compliant billing
• ✔ Protected long-term service line profitability

Conclusion

Instead of accepting unnecessary write-offs, this optometry practice preserved the profitability of its new TCD service line. Through persistent research, direct payer clarification, and compliant claim correction, FC Billing ensured proper Medicare reimbursement under the updated 2025 rules.