92066
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
$26.05
Non-Facility
$26.05
Documentation Required
- Refer to the member specific benefit plan document for details regarding benefit coverage and any plan-specific exclusions
- Requests for orthoptic vision therapy exceeding 12 visits for treatment of convergence insufficiency are subject to medical review (documentation to support medical necessity for >12 visits required).
- CPT codes 92065 and 92066 are 'covered if selection criteria are met' (documentation of meeting the selection criteria must be provided) — selection criteria text is referenced by the policy header 'CPT codes covered if selection criteria are met.'
- Check benefit plan descriptions for contract exclusions for vision therapy; documentation of plan benefits/coverage must be verified prior to payment.
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 [...]
- Orthoptic vision therapy is considered medically necessary for treatment of convergence insufficiency (up to 12 orthoptic vision therapy visits or sessions).
- CPT 92065 and 92066 are covered if selection criteria are met.
- ICD-10 codes covered if selection criteria are met: H51.11 - H51.12 (Convergence insufficiency and spasm) and H51.8 (Other specified disorders of binocular movement).
- oculomotor dysfunction
- accommodative and/or vergence disorders
9 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
AETNA-CPB-0489 — Orthoptic Vision Therapy
Related Codes
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