0687T — Tx amblyopia dev setup 1st
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
- Refer to the member specific benefit plan document for details regarding benefit coverage and any plan-specific exclusions
Key Coverage Criteria
- Occlusion Therapy or Pharmacologic Penalization Therapy for treating Amblyopia Orthoptic Therapy or Vision Therapy for treating Convergence Insufficiency Prism Adaptation Therapy for treating Esotropia American Optometric Association (AOA) — "research has demonstrated VT can be an effective treatment option for: Ocular motility dysfunctions (eye movement disorders)." American Optometric Association (AOA) — "research has demonstrated VT can be an effective treatment option for: Non-strabismic bin [...]
4 Active Policies
UHC-POL-visual-information-processing-evaluation-orthoptic-vision-therapy — Visual Information Processing Evaluation and Orthoptic and Vision Therapy
UMR-POL-UMR-visual-information-processing-evaluation-orthoptic-vision-therapy — Visual Information Processing Evaluation and Orthoptic and Vision Therapy
SUREST-POL-SUREST-visual-information-processing-evaluation-orthoptic-vision-therapy — Visual Information Processing Evaluation and Orthoptic and Vision Therapy
REGENCE-MED175.04 — Digital Therapeutic Products for Amblyopia
Related Codes
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