Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
A56692
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) is covered for evaluation and monitoring of optic nerve damage (CPT 92133) and a range of retinal diseases (CPT 92134), with specific frequency limits (optical nerve typically 1–2 tests/year; retinal usually no more than one exam per eye every two months). Monthly scans may be allowed for patients receiving active intravitreal therapy or for rapidly changing retinal/macular conditions; documentation must include provider assessment, relevant history, test results, signed records, and a valid ICD-10-CM diagnosis code. Billing is subject to NCCI/OPPS edits and ABN/modifier rules (GA/GX/GZ/GY) which can affect coverage and require specific claim elements such as occurrence code 32 and Form CMS-R-131 when applicable.
"SCODI (CPT 92133) is covered when performed to evaluate or monitor optic nerve damage/optic neuropathy."