Wiki CODING FOR OCT WITH OFFICE VISIT

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I cant find anything to guide me in the right direction. When I bill out for example 92004 (or 92014, 92012) with 92134 (or 92133) Medicare is denying 92134 for Medical Necessity on almost all of my claims. I have gone through the guidelines the diagnosis codes are falling under medically necessary per medicare article A56916. Can any one offer me advice on this?
 
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