Does 92134 require prior authorization?

No, 92134 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 92134?

Medicare facility rate: $1.97. Non-facility rate: $1.97. Work RVU: 0.31.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.31

Facility

$1.97

Non-Facility

$1.97

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.
Claims for SCODI must be submitted to the Part B MAC; bill all same‑day services for the same beneficiary/provider on the same claim.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
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.
Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

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

J05

L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J06

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

J06

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