Procedure 92065 Orthoptic/Pleoptic Training
When using procedure code 92065 Orthoptic and/or Pleoptic training, with continuing medical direction and evaluation you can bill as:
92065
92065 TC (technical component)
92065 26 (professional component - certain procedures are a combination of a physician component and a technical component. When the physician component is reported seperately, the service may be identified by adding modifier 26 to the usual procedure number)
Terminology identifies this procedure as including services for both eyes meaning this code is unilateral OR bilateral. You will not need to use modifier 50.
You will not use RT or LF modifiers and you won't want to bill using two units.
Suggestion: if you receive a denial "reject incorrect # of units billed" you will want to edit your claim and rebill . Usually you can do this with just a few click and submit electronic claims whenever you can for quicker turn around on your insurance payments.
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Does this type of coding work to get a bill paid with Molina....an insurance thru Medicaid?
ReplyDeleteI need to have my son's vision therapy covered for convergence insuffiency.
Hi Robsmomm -
ReplyDeleteI hate to hear your son has been diagnosed with Convergence Insufficiency which is usually a result of eyestrain, double vision, headaches and/or blurred vision. Most children identify this issue when they hit the reading stages but sometimes parents can identify the symptoms earlier by noticing children have short attention spans, squint eyes, rub eyes, blurred vision, sleepiness while reading, problems with motion sickness, trouble catching something thrown at them, trips on stairs or curbs, bumping into doors or other objects and poor posture.
Once a patient is identified with Convergence Insufficiency they will normally be directed to begin vision therapy to help re-establish the reflexes of convergence. The patient will come to the office to complete the therapy and usually sent home to complete eye exercises throughout the day.
Vision training therapy can be billed using procedure code 92065 (Orthoptic and/or Pleoptic Training, with continuing medical direction and evaluation).
Guidelines for using this code include: normally capped after so many visits (XX days each ins carrier can be different) within a 365 day period, 1 unit billable per visit, services must be ordered by a physician or optometrist, the provider needs to document a diagnosis and treatment plan, re-evaluation of the patient is usually required after so many weeks of treatment, and vision therapy completed by trained/certified staff under the direct supervision of an optometrist and or physician.
Diagnosis codes that validate the need for Vision Therapy:
368.01 Strabismic Amblyopia
368.02 Deprivation Amblyopia
368.03 Refractive Amblyopia
368.30 General Binocular Vision Disorder
368.31 Suppression of binocular vision
368.34 Abnormal retinal correspondence
367.51 Paresis of accommodation
367.52 Total or complete internal ophthalmoplegia
367.53 Spasm of accommodation
378.00 unspecified Esotropia
378.01 Monocular Esotropia
378.02 Monocular Esotropia with A Pattern
378.03 Monocular Esotropia with V pattern
378.04 Monocular Esotropia w/oth Noncomit
378.05 Alternating Esotropia
378.06 Alternating Esotropia w/A pattern
378.07 Alternating Esotropia w/V pattern
378.08 Alternating Esotropia w/Other noncomit
378.9 Unspecified disorder of eye movements
379.51 Nystagmus
379.57 Nystagmus w/deficiencies of saccadic eye movements
379.58 Nystagmus w/deficiencies of smooth pursuit movements
**also allowable with diagnoses of trauma and CVA
If your child receives Training Aids the office will bill a 99070 and will usually be required to include a statement of medical necessity when billing. (99070 – Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)
Now for your question – Does Molina Healthcare cover procedure code 92065?
I am currently not billing for any optometrists so my honest answer is I am not sure. I do know that most insurance carriers require a pre-authorization so I would recommend calling Molina of your state and ask them these questions:
1. Is pre-authorization required for 92065 with Molina Healthcare?
2. Is your child covered for procedure codes 92065, and or 99070(just in case the doctor ends up giving you training aids)
3. How many visits are you covered for?
4. How many visits each week can your child be treated for?
5. When does your child need to be re-evaluated?
I hope you found this information useful and if you have the time to let us know what you find out I would appreciate you letting us know!
Kind Regards,
Jennifer
Hi Robsmomm -
ReplyDeleteI hate to hear your son has been diagnosed with Convergence Insufficiency which is usually a result of eyestrain, double vision, headaches and/or blurred vision. Most children identify this issue when they hit the reading stages but sometimes parents can identify the symptoms earlier by noticing children have short attention spans, squint eyes, rub eyes, blurred vision, sleepiness while reading, problems with motion sickness, trouble catching something thrown at them, trips on stairs or curbs, bumping into doors or other objects and poor posture.
Once a patient is identified with Convergence Insufficiency they will normally be directed to begin vision therapy to help re-establish the reflexes of convergence. The patient will come to the office to complete the therapy and usually sent home to complete eye exercises throughout the day.
Vision training therapy can be billed using procedure code 92065 (Orthoptic and/or Pleoptic Training, with continuing medical direction and evaluation).
Guidelines for using this code include: normally capped after so many visits (XX days each ins carrier can be different) within a 365 day period, 1 unit billable per visit, services must be ordered by a physician or optometrist, the provider needs to document a diagnosis and treatment plan, re-evaluation of the patient is usually required after so many weeks of treatment, and vision therapy completed by trained/certified staff under the direct supervision of an optometrist and or physician.
Diagnosis codes that validate the need for Vision Therapy:
368.01 Strabismic Amblyopia
368.02 Deprivation Amblyopia
368.03 Refractive Amblyopia
368.30 General Binocular Vision Disorder
368.31 Suppression of binocular vision
368.34 Abnormal retinal correspondence
367.51 Paresis of accommodation
367.52 Total or complete internal ophthalmoplegia
367.53 Spasm of accommodation
378.00 unspecified Esotropia
378.01 Monocular Esotropia
378.02 Monocular Esotropia with A Pattern
378.03 Monocular Esotropia with V pattern
378.04 Monocular Esotropia w/oth Noncomit
378.05 Alternating Esotropia
378.06 Alternating Esotropia w/A pattern
378.07 Alternating Esotropia w/V pattern
378.08 Alternating Esotropia w/Other noncomit
378.9 Unspecified disorder of eye movements
379.51 Nystagmus
379.57 Nystagmus w/deficiencies of saccadic eye movements
379.58 Nystagmus w/deficiencies of smooth pursuit movements
**also allowable with diagnoses of trauma and CVA
If your child receives Training Aids the office will bill a 99070 and will usually be required to include a statement of medical necessity when billing. (99070 – Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)
Now for your question – Does Molina Healthcare cover procedure code 92065?
I am currently not billing for any optometrists so my honest answer is I am not sure. I do know that most insurance carriers require a pre-authorization so I would recommend calling Molina of your state and ask them these questions:
1. Is pre-authorization required for 92065 with Molina Healthcare?
2. Is your child covered for procedure codes 92065, and or 99070(just in case the doctor ends up giving you training aids)
3. How many visits are you covered for?
4. How many visits each week can your child be treated for?
5. When does your child need to be re-evaluated?
I hope you found this information useful and if you have the time to let us know what you find out I would appreciate you letting us know!
Kind Regards,
Jennifer