Optometry Coding & Billing Alert

Question: I received a notice from our carrier that it would not reimburse for -ocular photoscreening,- saying that it is -investigational and unproven.- What is ocular photoscreening, and what does it screen for?


New Mexico Subscriber

Answer: According to the 2005 edition of CPT Changes: An Insider's View, ocular photoscreening (described by temporary Category III code 0065T, Ocular photoscreening, with interpretation and report, bilateral) is -a new technology which makes it possible to detect a defect in a child's eye without the need of a response from the child during screening.-

A special device (such as the MTI Photoscreener or the Visiscreen 100) captures images of the pupillary reflexes and red reflexes and sends them to an evaluator. If the test finds abnormalities, a complete eye examination follows. The test may detect esotropia, exotropia, anisometropia, cataracts, ptosis, hyperopia and myopia.

But many carriers, like yours, are denying this service, citing an American Academy of Pediatrics report citing the need for further study. This includes Medicare Part B carriers like United HealthCare and TrailBlazer as well as private insurers like Aetna and Blue Cross/Blue Shield. Carriers consider it not medically necessary as an alternative to routine vision screening in infants and children.