Orthoptics (Vergence/Accommodative Therapy), Visual Exercises or Training

This policy covers orthoptics (vergence/accommodative) therapy and visual exercises/training — including office-based vergence/accommodative therapy and accommodative exercises — to improve convergence and accommodation function. Coverage is limited to symptomatic convergence insufficiency (including pediatric patients) and accommodative insufficiency when clinical diagnostic criteria are met and symptoms persist after at least 12 weeks of documented home-based therapy, with office-based treatment limited to 12 weeks; other uses (e.g., treatment of learning disabilities, most other visual disorders, and Vision Restoration Therapy for post‑stroke or neurotrauma visual field loss) are considered investigational/unproven and not covered.

"Office-based vergence/accommodative therapy for up to 12 weeks is medically necessary for individuals with symptomatic convergence insufficiency when symptoms persist despite a minimum of 12 weeks ..."