99174
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
$6.68
Non-Facility
$6.68
Documentation Required
- A vision screening program should record and report the screening results to the family, primary care provider/medical home, and when indicated the school or appropriate state agency. (NCCVH recommended practices summarized in policy)
- A best practice for children who fail vision screening includes documentation of the referral to and subsequent comprehensive eye examination by an optometrist or ophthalmologist (Cotter et al., 2015).
- Vision screening requires training and certification of screening personnel, acquiring sufficient and appropriate space, obtaining, and maintaining equipment and supplies, as well as recording and reporting the screening results. (NCCVH guidance summarized in policy)
- When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan. In the event of a conflict, the member specific benefit plan document governs. (Instructions for Use)
Key Coverage Criteria
- Instrument-based ocular photoscreening is proven and medically necessary for the following: - As a mass screening instrument for children 1-5 years of age (ends on 6th birthday); or - In individuals 6 years of age and older who are developmentally delayed and are unable or unwilling to cooperate with routine visual acuity screening
- Most UnitedHealthcare Commercial and Individual Exchange plans cover instrument-based screenings (CPT codes 99174 and 99177) as a preventive care services benefit in certain circumstances.
- Instrument-based screening techniques, such as photo - screening and autorefraction, are useful for assessing amblyopia and reduced-vision risk factors for children ages 1 to 5 years, as this is a critical time for visual development. (AAO guidance summarized in policy)
- Instrument-based screening can occur for children aged 6 years and older when children cannot participate in optotype-based screening. (AAO guidance summarized in policy)
- Diagnosis codes listed in the policy are those represented for development delay or those unable or unwilling to cooperate with routine visual acuity screening (examples include: F70-F79, F80.x-F81.x, F82, F84.x-F89, F90.x, G80.x, H93.25, multiple Q codes for chromosomal and congenital conditions, R41.840, R62.0, Z91.198, Z91.199, Z91.A98).
- Aetna considers one ocular photoscreening medically necessary for screening all children 3 years of age.
5 Active Policies
UHC-POL-ocular-photoscreening — Ocular Photoscreening
UMR-POL-UMR-ocular-photoscreening — Ocular Photoscreening
SUREST-POL-SUREST-ocular-photoscreening — Ocular Photoscreening
CIGNA-A004 — Preventive Care Services - (A004)
AETNA-CPB-0689 — Ocular Photoscreening
Related Codes
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