Ocular Photoscreening – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare deems instrument‑based ocular photoscreening medically necessary as a mass screening tool for children aged 1–5 years (ending on the 6th birthday) and for individuals ≥6 years with developmental delay who cannot cooperate with routine visual acuity testing, but it is not medically necessary for children <1 year or for other individuals and retinal birefringence/retinal polarization scanning is specifically unproven and not medically necessary for detecting strabismus. Most Commercial and Individual Exchange plans cover CPTs 99174 and 99177 as preventive services in certain circumstances but coverage is governed by the member‑specific benefit plan; programs must use trained/certified screeners, maintain equipment, document and report results, and refer failed screens for a comprehensive eye exam.

"Instrument-based ocular photoscreening is proven and medically necessary for the following: - As a mass screening instrument for children 1-5 years of age (ends on 6th birthday); or - In individual..."