| Mountain State Medical Policy Bulletin |
| Section: | Diagnostic Medical |
| Number: | M-47 |
| Topic: | Automated Visual Field Examinations |
| Effective Date: | April 9, 2007 |
| Issued Date: | September 10, 2007 |
| Date Last Reviewed: | 03/2007 |
Indications and Limitations of Coverage
Automated visual field examinations can be performed on patients with no signs or symptoms of disease, and on symptomatic patients to aid in diagnosis or treatment. An automated visual field examination performed in conjunction with a routine eye examination on an asymptomatic patient is considered to be screening and is generally noncovered except for those groups/programs identified in benefits. Automated visual field testing performed in conjunction with a vision examination for prescribing or fitting eyeglasses or contact lenses is not a benefit under the medical-surgical programs. Automated visual field examinations (92081-92083) are considered medically necessary and payable for the conditions/indications listed in the Text Attachment below. Automated visual field examinations reported for medical conditions/indications other than those listed in the Text Attachment below will be denied as not medically necessary. A participating, preferred, or network provider is not permitted to bill the patient for these services. Automated visual field testing that is not covered as a screening test or is not a benefit is not covered. A participating, preferred, or network provider can bill the member for the denied service. All services for automated visual field examinations (92081 - 92083) are considered bilateral. Separate payment will not be made for each eye. Codes 92081 - 92083 should be used as appropriate to report "untaped" automated visual field examinations. Code 92499 should be used to report a "taped" automated visual field examination. A complete description of the service performed should be included in the narrative section of the electronic or paper claim.
Description Visual field testing is a process to determine defects in the field of vision and to test the function of the retina, optic nerve, and optic pathways. Visual field testing may be kinetic or static. In kinetic testing (i.e., Goldmann or tangent screen), the stimulus is moved to different areas and the point at which it is first seen by the patient is marked. In static (stationary) perimetry, a specific point is chosen for examination and the stimulus is increased until its threshold is determined. More complex studies with automated and computerized machines can accomplish this type of visual examination. |
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| 92081 | 92082 | 92083 | 92499 |
This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits are determined by the Federal Employee Program. |
| [Version 002 of M-47] |
| [Version 001 of M-47] |
Conditions/Indications
094.81-094.89 |