Optometry Coding & Billing Alert

Published on Mon Apr 11, 2005 PDF

The carrier now considers 92135 medically necessary in some - but not all - cases

If you're tired of not getting paid by Aetna for scanning laser glaucoma testing (SLGT), take heart: It looks as if the insurance agency has seen the light.

Last month, we explained different coding scenarios for SLGT procedures, and the diagnoses that different carriers would accept as medically necessary (see "Spotlight Modifiers for SLGT to Stop Getting Zapped by Payers" in the April 2005 Optometry Coding & Billing Alert). We also mentioned that carrier rules for reimbursement varied, and that Aetna "still considers the scanning laser 'experimental and investigational' and will not approve 92135 (Scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral) for any diagnosis."

On April 1, 2005, Aetna changed its tune. According to its Clinical Policy Bulletin 0344, Aetna now "considers optic nerve and retinal imaging methods medically necessary for documenting the appearance of the optic nerve head and retina in persons with glaucoma, glaucoma suspects, and other diseases affecting the optic nerve head and retina."

The insurance carrier still considers the scanning laser "experimental and investigational as a screening test for glaucoma and other retinal diseases."

To read the complete Aetna bulletin, visit www.aetna.com/cpb/data/CPBA0344.html.