Preventative (Routine) Eye Examination

This policy covers preventive (routine) ophthalmic examinations—including comprehensive and periodic evaluations with intraocular pressure measurement (preferably contact applanation tonometry), fundus exam and pharmacologic dilation when indicated—to detect common and serious ocular disease and monitor at‑risk patients (e.g., glaucoma, diabetic retinopathy, age‑related macular degeneration), with age‑based interval recommendations (adults <40: every 5–10 years; 40–54: every 2–4 years; 55–64: every 1–3 years; ≥65: every 1–2 years) and pediatric exams governed by a separate policy. Coverage is limited to the specified frequency intervals and is subject to documentation, coding and valid signature requirements, retrospective review, and exclusions (e.g., headache diagnoses do not qualify); tonometry may be deferred for suspected infection or corneal trauma.

"Routine preventive ophthalmic evaluation to detect common and serious ocular abnormalities."