• Frequency of Retina OCT


    Question: We are receiving many denials for CPT code 92134 Retina OCT due to frequency. However, our office hasn’t performed the test in two months. Should we appeal?

    Answer: Medicare administrative contractors (MACs) have limited the frequency to one per month for active retinal disease and no more than one test every two months when disease is not active.

    The frequency edit is per patient, not per physician. So if another physician performed the test within the last month, your test may be denied. Confirm frequency edits with your commercial payers that don’t follow Medicare’s guidelines.

    Learn more about testing in Retina Complete Reference Guide.