Does 92132 require prior authorization?

No, 92132 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 92132?

Medicare facility rate: $1.93. Non-facility rate: $1.93. Work RVU: 0.28.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.28

Facility

$1.93

Non-Facility

$1.93

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
When both procedures are performed, append modifier 59 and provide clear medical record documentation explaining the clinical necessity and how the services are distinct.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
When distinct clinical circumstances require both SCODI (CPT 92133 or 92134) and fundus photography (CPT 92250) to evaluate or treat the patient, both procedures may be reported together with modifier 59 to indicate a distinct procedural service.
SCODI (CPT 92133, 92134) is considered medically reasonable and necessary for evaluation of retinal disorders, glaucoma, and anterior segment disorders as documented in LCD L34760.
Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when medically reasonable and necessary for management of retinal conditions undergoing active treatment, per LCD L35038.
SCODI is indicated for management of patients with retinal conditions who are undergoing active treatment, per LCD L33751 reasonable and necessary guidelines.
Follow the full reasonable and necessary criteria in LCD L33751 to determine medical necessity for SCODI services.

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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A56916 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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A56537 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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Ask Verity about documentation requirements, denial risks, or coverage in your state.