0464T — Visual ep test for glaucoma
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim.
- The diagnosis code(s) submitted must accurately and specifically describe the patient's condition for which the visual electrophysiology test was performed.
- Follow applicable NCCI and OPPS billing requirements and edits prior to claim submission as coding may be affected by these edits.
- Medical record documentation must demonstrate that VEP/VER is being used when clinical criteria (e.g., for multiple sclerosis) are inconclusive and justify the need for the test.
Key Coverage Criteria
- VEP/VER is covered to confirm the diagnosis of multiple sclerosis when clinical diagnostic criteria are inconclusive.
- VEP/VER is covered to evaluate diseases of the optic nerve including optic neuritis, ischemic optic neuropathy, toxic amblyopia, nutritional amblyopia, neoplasm compressing anterior visual pathways, optic nerve injury, or optic atrophy.
- VEP/VER is covered to evaluate suspected malingering or functional vision loss to help rule out nonorganic vision loss.
- VEP/VER is covered for intraoperative monitoring of the visual system during optic nerve or related surgery (monitoring of short-latency evoked potentials).
- Full-field electroretinography (ERG) is covered to detect loss of retinal function or to distinguish retinal lesions from optic nerve lesions.
- ERG is covered for toxic retinopathies, including toxicity from intraocular metallic foreign bodies and vigabatrin exposure.
2 Active Policies
A57060 — Billing and Coding: Visual Electrophysiology Testing
J06
L36831 — Visual Electrophysiology Testing
J06
Related Codes
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