Does 92145 require prior authorization?

No, 92145 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 92145?

Medicare facility rate: $13.69. Non-facility rate: $13.69. Work RVU: 0.10.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.10

Facility

$13.69

Non-Facility

$13.69

This coding guidance complements Local Coverage Determination L38014; refer to LCD L38014 for full coding/details.
For billed visual field and imaging services, interpretation and report must be present (CPT descriptors: 'with interpretation and report')
Clinical records demonstrating medical necessity for evaluation of primary open-angle glaucoma (e.g., findings from ophthalmic exam, gonioscopy results, visual field test results, optic nerve/RNFL imaging) to justify testing
When a service/technology is billed that is listed as experimental/investigational or not covered (see limitations), documentation must support why the service is being used; however, Aetna considers those services investigational and not covered per policy

No explicit 'Indications' or 'Covered Indications' section appears in this document excerpt.
Inferred (based on references cited): diagnosis and monitoring of glaucoma (including open-angle glaucoma and normal-tension glaucoma).
Inferred (based on references cited): measurement/monitoring of intraocular pressure (tonometry), including clinic and home tonometry (e.g., iCare Home tonometer).
Inferred (based on references cited): assessment of corneal biomechanical properties (e.g., corneal hysteresis, corneal resistance factor) as risk factors or biomarkers in glaucoma evaluation.
Inferred (based on references cited): measurement/analysis of ocular blood flow (pulsatile ocular blood flow, ocular blood flow tonometer) in ocular disease evaluation.
Inferred (based on references cited): use of visual electrophysiology (visual evoked potentials, multifocal VEP) and other objective perimetry techniques for detection/diagnosis of glaucomatous field defects.

A56910 — Billing and Coding: Corneal Hysteresis

J05

L38211 — Corneal Hysteresis

J05

L38014 — Corneal Hysteresis

J06

A56248 — Billing and Coding: Corneal Hysteresis

J06

WPS-L38211 — Corneal Hysteresis

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