Extended Ophthalmoscopy

This policy covers extended ophthalmoscopy (e.g., dilated indirect ophthalmoscopy, contact lens biomicroscopy, scleral depression) for detailed evaluation, imaging and documentation of posterior segment pathology such as retinopathy of prematurity, diabetic and hypertensive retinopathy, retinal tears/detachments and neoplasms, optic nerve disease, glaucoma, and other retinal disorders. It is not covered for routine documentation of a healthy retina, duplication when equivalent testing (fundus photography/angiography) provides no new clinical information, or repeated exams for stable disease; exams must be performed by a duly licensed eye care provider and coverage is subject to the member’s plan terms and applicable laws.

"Infants undergoing treatment and/or monitoring of retinopathy of prematurity."

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