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Vision Therapy/Orthoptics and Pleoptics
| Vision Therapy/Orthoptics and Pleoptics | ||
|---|---|---|
| Procedure Code | Brief Definition | Authorization Requirements |
| 92065 | Orthoptic and/or pleoptic training, with continuing medical direction and evaluation | No authorization is required for any PrimeWest Health groups |
Visual Therapy/Orthoptics/Pleoptics Coverage Criteria
This service must be provided only when the following criteria are met. If, during an audit, the medical record does not have indication of these criteria, any payment made towards orthoptic and/or pleoptic training may be recovered by PrimeWest Health due to not meeting medical criteria.
- Diagnosis and treatment of amblyopia, sensory or motor strabismus, and accommodative disorders causing subjective visual complaints that are not relieved by wearing prescription eyewear
- Home visual therapy is to be used, including home treatment with patching, lens fogging, red/green/polaroid filters, and other lenses/devices
- Visual therapy for amblyopia is limited to children under age 10. If improvement is not noted after four sessions, the member must be referred to an appropriate professional (e.g., neurologist or ophthalmologist) for further evaluation.
Billing for Ocular Photodynamic Therapy (CPT code 67221) is covered only for ICD-10-CM H35.3210 – H35.3293 (exudative age-related macular degeneration). No separate payment for the intravenous infusion service is allowed. Payment for the infusion is packaged into CPT code 67221.
Payment Limitations
The physician monitoring progress may bill for a limited examination in addition to the orthoptic/pleoptic training. Documentation in the medical record that the physician has seen the member and performed the necessary procedures for a limited examination is required. Examinations to evaluate visual therapy are limited to one per week.
PW_11-19_573
Updated_06/14/2022
