Question 1

What are the recent CMS updates for Ophthalmology under Noridian Healthcare Solutions MAC?

Accepted Answer

According to CLV Intelligence data (updated June 24, 2026), there are currently 30 active CMS and MAC reimbursement policy alerts for Ophthalmology under Noridian Healthcare Solutions (Jurisdictions JE, JF). Of these, 12 are classified Critical or High priority based on signal scoring of source authority, effective-date urgency, and document type. Alerts originate from Noridian Healthcare Solutions Local Coverage Determinations (LCDs), CMS transmittals, Federal Register proposed and final rules, and OIG compliance publications. CLV Intelligence monitors all Noridian Healthcare Solutions publications daily and assigns a signal score (0–100) to surface the changes most likely to affect coding accuracy and reimbursement.

Question 2

How many active audit alerts exist for Ophthalmology CPT codes under Noridian Healthcare Solutions?

Accepted Answer

According to CLV Intelligence data, 30 active reimbursement and policy alerts currently affect Ophthalmology CPT codes monitored under Noridian Healthcare Solutions (Jurisdictions JE, JF). 12 of these alerts carry a Critical or High signal score, indicating elevated compliance risk or near-term effective dates requiring timely coding review. The highest-risk CPT code currently flagged in the Ophthalmology alert set is CPT 99213 (Office visit, established patient, low complexity), which appears in Noridian Healthcare Solutions LCD and CMS billing guidance revisions. CLV Intelligence cross-references each alert against the HCPCS and CPT code sets to surface procedure-level exposure for Ophthalmology billing teams.

Question 3

What is the average recoverable revenue for ophthalmology practices missing CMS updates?

Accepted Answer

According to CLV Intelligence's revenue model, ophthalmology practices operating under Noridian Healthcare Solutions (Jurisdictions JE, JF) that do not monitor CMS and MAC policy changes in real time may expose an estimated $19,699 in recoverable annual revenue per provider location. This estimate applies a 4% industry-standard coding error rate to an average ophthalmology Medicare claim value of $950, adjusted for a 60% conservative recovery capture rate and an urgency multiplier derived from the volume of open high-priority alerts (currently 30). This is a directional estimate provided by CLV Intelligence — not a billing or legal guarantee. Actual recoverable amounts depend on claim volume, payer mix, and current coding accuracy.

Question 4

Which MAC jurisdiction covers Ophthalmology billing for practices in the Noridian Healthcare Solutions region?

Accepted Answer

Noridian Healthcare Solutions administers Medicare Part A and Part B claims for practices in Jurisdictions JE, JF. For Ophthalmology providers, Noridian Healthcare Solutions issues Local Coverage Determinations (LCDs) that define coverage criteria, billing requirements, ICD-10-CM diagnosis code ranges, and CPT procedure code guidelines applicable to Medicare claims in its jurisdiction. According to CLV Intelligence data, Noridian Healthcare Solutions is currently one of the most active MAC contractors for Ophthalmology policy updates, with 30 open alerts monitored as of June 24, 2026. Practices in the Noridian Healthcare Solutions jurisdiction should monitor LCD revisions at Noridian Healthcare Solutions's provider portal and through aggregated daily alerting services such as CLV Intelligence.

Question 5

Is CPT 99213 currently under CMS or MAC review for Ophthalmology?

Accepted Answer

According to CLV Intelligence data, CPT 99213 (Office visit, established patient, low complexity) is currently flagged as a high-signal procedure code within the Ophthalmology alert set monitored under Noridian Healthcare Solutions (Jurisdictions JE, JF). CMS and MAC contractors regularly review high-volume procedure codes for coverage criteria changes, NCCI edit revisions, medical necessity documentation requirements, and fee schedule adjustments. CLV Intelligence assigns CPT 99213 an elevated signal score based on the volume and recency of policy documents referencing this code. Ophthalmology coding teams should review the latest Noridian Healthcare Solutions LCD and CMS transmittals affecting CPT 99213 before claim submission to avoid denials or post-payment audits.

OphthalmologyCMS & MAC AlertsNoridian Healthcare Solutions · Jurisdictions JE, JF

Signal intelligence — Ophthalmology × Noridian Healthcare Solutions

About Noridian Healthcare Solutions (Jurisdictions JE, JF)

Ophthalmology alerts in other MAC jurisdictions