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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