NHIC Adds 95930 Coverage

NHIC, Corp.’s “April 2012 Ophthalmology Optometry Billing Guide” includes a single, yet important, revision. Under the heading “Evoked Response Tests – NCD,” on page 10, the jurisdiction 14 Part B Medicare administrative contractor (MAC) has added coverage for CPT® procedure code 95930 Visual evoked potential (VEP) testing central nervous system, checkerboard or flash.

NHIC, Corp. says in the guide that it will reimburse claims for 95930 based on medical necessity, effective for services rendered on or after April 13, 2012.

According to the National Coverage Determination (NCD) for Evoked Response Tests (160.10), “These tests measure brain responses to repetitive visual, click or other stimuli.”

Just about any diagnosis of a condition that affects visual function would give cause for VEP testing. Diagnosis codes may include, but are not limited to:

V20.2 – Routine infant or child health check

V58.62 – Long-term (current) use of antibiotics

V58.69 – Long-term (current) use of other medications

V80.2 – Special screening for other eye conditions

088.81 – Lyme disease

340.xx – Multiple sclerosis

368.00-368.9 – Visual disturbances

378.9 – Unspecified disorder of eye movements

430-435.9 – Intracranial and cerebral disorders

780.4 – Dizziness and giddiness

781.3 – Lack of coordination

784.3 – Aphasia

854.x – Intracranial injury of other and unspecified nature

950.0-950.9 – Injury to optic nerve and pathways


Check your contractor’s local coverage determination (LCD) for specific billing guidance.

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