CG-MED-85 Posterior Segment Optical Coherence Tomography

This policy addresses posterior segment optical coherence tomography (OCT) of the eye. It is covered for initial imaging to establish a diagnosis of an optic nerve or retinal condition when the clinical diagnosis is uncertain, or to set a baseline before treatment, and for repeat imaging to monitor such conditions when documented changes on OCT are expected to impact management (e.g., glaucoma, optic neuropathy, macular degeneration, diabetic retinopathy, macular edema). OCT is not covered when these criteria are not met and for other indications, including multiple sclerosis and amyloidosis.

"Initial optical coherence tomography of the posterior segment of the eye is consideredmedically necessaryfor any of the following:"

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