JUL 21, 2021
If visual fields and retinal nerve fiber layer OCTs are performed on the same day, are they covered by insurance?
Question: Is there any website or person that I can contact to find out if visual fields and retinal nerve fiber layer (RNFL ) OCTs are covered by insurance if performed on the same day? I have been told many different things regarding this and want to find out what is accurate.
Answer: The answer lies in the National Correct Coding Initiative (NCCI or CCI) edit files, which can be found in the Coding Coach Complete Ophthalmic Coding Reference and Retina Coding Complete Reference Guide or with a link to CMS data files at Coding Updates and Resources. CCI does not bundle these two tests when performed on the same day. There are, however, frequency edits for performance that vary per payer. Please see your Medicare administrative contractor (MAC) policies and articles at aao.org/lcds.