Scanning Computerized Ophthalmic Diagnostic Imaging

SCODI (including SLP, OCT, and CSLO) is covered when used for evaluation of anterior-segment glaucoma/corneal/iris/ciliary body disorders and for posterior-segment indications including diagnosis/management of glaucoma (all stages), monitoring CQ/HCQ therapy for retinopathy, and evaluation of optic nerve or retinal diseases (e.g., AMD, DR, macular edema). SCODI is not covered for asymptomatic screening or when used only to confirm an already-established diagnosis; fundus photography and posterior-segment SCODI on the same eye the same day are generally mutually exclusive unless medical necessity for both is clearly documented. Documentation in the medical record must show the test was used to establish diagnosis, a baseline, or for monitoring, and services are subject to CMS rules, local coverage determinations (e.g., L35448 for IDTFs), post-payment review, and audits.

"Anterior-segment SCODI is medically reasonable and necessary for evaluation of specified forms of glaucoma and certain disorders of the cornea, iris, and ciliary body."