Visual Field Testing

This policy covers visual field testing for evaluation and monitoring of visual function in conditions such as glaucoma or glaucoma suspect, diabetic and hypertensive retinopathy, macular pathology, optic nerve disease (e.g., papilledema, optic atrophy, compressive lesions), retinal vascular occlusions and other retinal disorders, intracranial masses/increased intracranial pressure, ocular injury, and pretreatment retinal detachment assessment. Testing is not medically necessary for repeated assessment of a stable diagnosed condition and is generally limited to no more than twice per year for controlled glaucoma; SWAP has practical and reliability limitations, gross confrontation and computerized screening fields are included in general ophthalmologic services and not separately reportable, and state Medicaid and applicable Medicare coverage determinations supersede this policy.

"Malpositioning of the upper eyelid, including dermatochalasia, blepharochalasia, blepharoptosis, brow ptosis, or eyelid injury."