92065
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.69
Facility
$27.39
Non-Facility
$38.41
Documentation Required
- Refer to the member specific benefit plan document for details regarding benefit coverage and any plan-specific exclusions
- Ocular defects should be identified as early as possible and when correctable, managed by the ophthalmologist.
- The policy does not provide a specific 'Documentation Requirements' section or explicit list of required documentation.
- Inferred from policy context: documentation of multidisciplinary assessment (educational and psychological specialist assessments) for individuals at risk for learning disabilities/dyslexia.
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 [...]
- Convergence exercises effectively treated convergence insufficiency (CI) in otherwise healthy patients.
- Early comprehensive educational, psychological, and medical assessment for individuals considered to be at risk for learning disabilities, dyslexia or attention defects.
- Educational remediation combined with appropriate psychological and medical treatment for individuals with learning disabilities/dyslexia.
- Identification and management by an ophthalmologist of ocular defects that are correctable (e.g., reduced visual acuity, refractive errors such as farsightedness) in children or adults with reading difficulties.
- Referral to a primary care physician to coordinate required multidisciplinary care when no ocular defect is found.
14 Active Policies
AMBETTER-CP.BH.124 — Attention Deficit Hyperactivity Disorder Assessment and Treatment
AETNA-CPB-0078 — Learning Disabilities, Dyslexia, and Vision
CARELON-physical-therapy-occupational-therapy-and-speech-therapy-2024-04-14 — Physical Therapy Occupational Therapy and Speech Therapy
UHC-POL-visual-information-processing-evaluation-orthoptic-vision-therapy — Visual Information Processing Evaluation and Orthoptic and Vision Therapy
Related Codes
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