LCD/NCD Portal

L29241

 

OPHTHALMOLOGICAL DIAGNOSTIC SERVICES

 

01/01/2013

 

Indications and Limitations of Coverage and/or Medical Necessity

• Diagnostic ophthalmological services (92018-92499) rendered by a physician are covered services when medically necessary and reasonable for the patient's condition.

• Routine eye examinations for the purpose of

o prescribing,

o fitting, or

o Changing eyeglasses or contact lens (es).

• Eye refractions are noncovered.

 

CPT/HCPCS Codes

 

 

92284 DARK ADAPTATION EXAMINATION WITH INTERPRETATION AND REPORT

92286 ANTERIOR SEGMENT IMAGING WITH INTERPRETATION AND REPORT; WITH SPECULAR MICROSCOPY AND ENDOTHELIAL CELL ANALYSIS

92287 ANTERIOR SEGMENT IMAGING WITH INTERPRETATION AND REPORT; WITH FLUORESCEIN ANGIOGRAPHY

 

 

ICD-9 Codes that Support Medical Necessity

 

 

Dark Adaptation Examination (CPT Code 92284):

 

 

264.5 VITAMIN A DEFICIENCY WITH NIGHT BLINDNESS

362.74 PIGMENTARY RETINAL DYSTROPHY

365.20 PRIMARY ANGLE-CLOSURE GLAUCOMA UNSPECIFIED

368.60 NIGHT BLINDNESS UNSPECIFIED

 

Endothelial Cell Photography (CPT Code 92286):

 

371.20 CORNEAL EDEMA UNSPECIFIED

371.21 IDIOPATHIC CORNEAL EDEMA

371.22 SECONDARY CORNEAL EDEMA

371.23 BULLOUS KERATOPATHY

371.57 ENDOTHELIAL CORNEAL DYSTROPHY

371.58 OTHER POSTERIOR CORNEAL DYSTROPHIES

379.31 APHAKIA

743.35 CONGENITAL APHAKIA

V43.1 LENS REPLACED BY OTHER MEANS

 

Special Anterior Segment Photography (CPT Code 92287):

 

190.0 MALIGNANT NEOPLASM OF EYEBALL EXCEPT CONJUNCTIVA CORNEA RETINA AND CHOROID

250.50 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.51 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE I [JUVENILE TYPE], NOT STATED AS UNCONTROLLED

250.52 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.53 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED

364.00 ACUTE AND SUBACUTE IRIDOCYCLITIS UNSPECIFIED

364.01 PRIMARY IRIDOCYCLITIS

364.02 RECURRENT IRIDOCYCLITIS

364.03 SECONDARY IRIDOCYCLITIS INFECTIOUS

364.04 SECONDARY IRIDOCYCLITIS NONINFECTIOUS

364.05 HYPOPYON

364.10 CHRONIC IRIDOCYCLITIS UNSPECIFIED

364.11 CHRONIC IRIDOCYCLITIS IN DISEASES CLASSIFIED ELSEWHERE

364.21 FUCHS' HETEROCHROMIC CYCLITIS

364.22 GLAUCOMATOCYCLITIC CRISES

364.23 LENS-INDUCED IRIDOCYCLITIS

364.24 VOGT-KOYANAGI SYNDROME

364.3 UNSPECIFIED IRIDOCYCLITIS

364.41 HYPHEMA OF IRIS AND CILIARY BODY

364.42 RUBEOSIS IRIDIS

364.51 ESSENTIAL OR PROGRESSIVE IRIS ATROPHY

364.52 IRIDOSCHISIS

364.53 PIGMENTARY IRIS DEGENERATION

364.54 DEGENERATION OF PUPILLARY MARGIN

364.55 MIOTIC CYSTS OF PUPILLARY MARGIN

364.56 DEGENERATIVE CHANGES OF CHAMBER ANGLE

364.57 DEGENERATIVE CHANGES OF CILIARY BODY

364.59 OTHER IRIS ATROPHY

364.60 IDIOPATHIC CYSTS OF IRIS AND CILIARY BODY

364.61 IMPLANTATION CYSTS OF IRIS AND CILIARY BODY

364.62 EXUDATIVE CYSTS OF IRIS OR ANTERIOR CHAMBER

364.63 PRIMARY CYST OF PARS PLANA

364.64 EXUDATIVE CYST OF PARS PLANA

364.70 ADHESIONS OF IRIS UNSPECIFIED

364.71 POSTERIOR SYNECHIAE OF IRIS

364.72 ANTERIOR SYNECHIAE OF IRIS

364.73 GONIOSYNECHIAE

364.74 ADHESIONS AND DISRUPTIONS OF PUPILLARY MEMBRANES

364.75 PUPILLARY ABNORMALITIES

364.76 IRIDODIALYSIS

364.77 RECESSION OF CHAMBER ANGLE OF EYE

364.81 FLOPPY IRIS SYNDROME

364.82 PLATEAU IRIS SYNDROME

364.89 OTHER DISORDERS OF IRIS AND CILIARY BODY

365.41 GLAUCOMA ASSOCIATED WITH CHAMBER ANGLE ANOMALIES

365.42 GLAUCOMA ASSOCIATED WITH ANOMALIES OF IRIS

365.43 GLAUCOMA ASSOCIATED WITH OTHER ANTERIOR SEGMENT ANOMALIES

365.44 GLAUCOMA ASSOCIATED WITH SYSTEMIC SYNDROMES

365.52 PSEUDOEXFOLIATION GLAUCOMA

365.63 GLAUCOMA ASSOCIATED WITH VASCULAR DISORDERS OF EYE

365.64 GLAUCOMA ASSOCIATED WITH TUMORS OR CYSTS

365.82 GLAUCOMA WITH INCREASED EPISCLERAL VENOUS PRESSURE

743.00 CLINICAL ANOPHTHALMOS UNSPECIFIED

743.03 CYSTIC EYEBALL CONGENITAL

743.06 CRYPTOPHTHALMOS

743.10 MICROPHTHALMOS UNSPECIFIED

743.11 SIMPLE MICROPHTHALMOS

743.12 MICROPHTHALMOS ASSOCIATED WITH OTHER ANOMALIES OF EYE AND ADNEXA

743.20 BUPHTHALMOS UNSPECIFIED

743.21 SIMPLE BUPHTHALMOS

743.22 BUPHTHALMOS ASSOCIATED WITH OTHER OCULAR ANOMALIES

743.30 CONGENITAL CATARACT UNSPECIFIED

743.31 CONGENITAL CAPSULAR AND SUBCAPSULAR CATARACT

743.32 CONGENITAL CORTICAL AND ZONULAR CATARACT

743.33 CONGENITAL NUCLEAR CATARACT

743.34 CONGENITAL TOTAL AND SUBTOTAL CATARACT

743.35 CONGENITAL APHAKIA

743.36 CONGENITAL ANOMALIES OF LENS SHAPE

743.37 CONGENITAL ECTOPIC LENS

743.39 OTHER CONGENITAL CATARACT AND LENS ANOMALIES

743.41 CONGENITAL ANOMALIES OF CORNEAL SIZE AND SHAPE

743.42 CONGENITAL CORNEAL OPACITIES INTERFERING WITH VISION

743.43 OTHER CONGENITAL CORNEAL OPACITIES

743.44 SPECIFIED CONGENITAL ANOMALIES OF ANTERIOR CHAMBER CHAMBER ANGLE AND RELATED STRUCTURES

743.45 ANIRIDIA

743.46 OTHER SPECIFIED CONGENITAL ANOMALIES OF IRIS AND CILIARY BODY

743.47 SPECIFIED CONGENITAL ANOMALIES OF SCLERA

743.48 MULTIPLE AND COMBINED CONGENITAL ANOMALIES OF ANTERIOR SEGMENT

 

 

Documentation Requirements

• Office Notes supplying documentation of complaint or symptomatology for visual disturbances and the effect on activities of daily living

• Diagnostic test results

• The provider has a responsibility to maintain a record for post-payment audit.

 

Sources of Information and Basis for Decision

 

N/A

 

01/01/2013

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

CMS LCD L29241 Ophthalmological Diagnostic Services