Reimbursement for Extended Color Vision Testing (Waggoner)
FREQUENTLY ASKED QUESTIONS
Reimbursement for Extended Color Vision Testing
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Q What is Waggoner Diagnostics’ Computerized Color Vision Test (WCCVT)?
A The Waggoner CCVT is a family of color vision tests that runs on a variety of web browsers, Windows tablets, computers, or tablets running Android/iOS.1 The software uses patient responses to select the next randomized presentation. CCVT has a screening version and fully diagnostic adult and pediatric versions. Protan, deutan, and tritan defects can be finely graded in the diagnostic version. CCVT tests are self-guided and standardized. The auto-scored results may be printed or stored electronically in the patient’s medical record.
Q What are the indications for color vision testing?
A Color vision testing is done for a variety of reasons including: congenital or acquired color vision defects, optic nerve problems, and for monitoring certain high-risk potentially toxic medications.2 Additionally, vocational assessment of color vision is important to qualify for and continue in certain civilian and military occupations.3
Q What CPT code describes color vision testing?
A CPT 92283 (Color vision examination, extended, e.g., anomaloscope or equivalent) describes color vision testing that is more extensive and rigorous than is typically done during an eye exam. CPT states, “Color vision testing with pseudoisochromatic plates (such as HRR or Ishihara) is not reported separately. It is included in the appropriate general or ophthalmological service”. The diagnostic portion of the Waggoner CCVT satisfies 92283, but the screening portion is akin to HRR or Ishihara.
Q Is color vision testing covered by Medicare and other payers?
A Sometimes. Basic color vision testing using pseudoisochromatic plates is covered as part of the eye exam. More extensive color vision testing may be ordered when a patient fails the basic color vision test or has a sign, symptom or family history that warrants further assessment. Coverage depends on the indications as well as the results of the extended testing and the physician’s interpretation.
Q What documentation is required in the medical record to support claims for extended color vision testing?
A Beside the CCVT results, the chart note should contain these elements:
- Physician’s order – (e.g., Extended color vision testing to rule out Plaquenil macula toxicity – patient unable to complete 10-2 HVF)
- Reliability of the test – (e.g., Prompt responses)
- Findings – (e.g., Red-green defects OU)
- Assessment, diagnosis – (e.g., Plaquenil macula toxicity OU; no prior hx of color vision defects)
- Impact on treatment, prognosis – (e.g., Recommend discontinuing Plaquenil, letter to Rheumatology)
- Physician’s signature
Q Must the physician be present while this test is performed?
A Under Medicare program standards, this test needs only general supervision. General supervision means the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required. Check state laws for additional requirements.
Q What does Medicare allow for extended color vision testing?
A CPT 92283 is per patient, not per eye. The 2021 Medicare Physician Fee Schedule allowable is $55.48. Of this amount, $46.41 is assigned to the technical component and $9.07 for the professional component. Medicare allowable amounts are adjusted in each area by local wage indices; other payers set their own rates.
This test is subject to Medicare’s Multiple Procedure Payment Reduction (MPPR). This reduces the allowable for the technical portion of the lesser-valued test when two or more tests on the MPPR list are performed on the same day.4
Q What is the frequency of extended color vision testing (CPT 92283) in the Medicare program?
A Extended color vision testing is rare within the Medicare program. For ophthalmology and optometry combined, it was reported 3 times per 10,000 eye exams. Since most color vision testing is not “extended”, it is as an incidental part of an eye exam. The utilization of 92283 is significantly less than the prevalence of color vision deficit in the population.
Q How often may this test be repeated?
A In general, this and all diagnostic tests are reimbursed when medically indicated. Clear documentation of the reason for testing is always required. Too-frequent testing can garner unwanted attention from Medicare and other payers.
Q Is this test bundled with other services?
A Yes. According to Medicare’s National Correct Coding Initiative (NCCI), CPT 99211 is bundled with 92283. When these services are billed together, only 92283 will be paid.
Q May we ever bill the patient for color vision testing?
A Yes; sometimes a physician may feel that the test is merited even though his or her reasons do not agree with Medicare’s coverage policies. In the situation where Medicare Part B might not cover the test, an Advance Beneficiary Notice of Noncoverage (ABN) should be signed by the patient prior to testing. Do not use the official ABN for non-Part B payers. You may collect your fee from the patient at the time of the service or wait for a Medicare denial after a claim is filed. If both the patient and Medicare pay, promptly refund the patient or show why Medicare paid in error.
1 Waggoner Diagnostics. Computerized Color Vision Test. Link here.
2 Fraunfelder et.al. Clinical Ocular Toxicology. 2008;10:320-321
3 Raymond RB, Ivan DJ. Raymond’s Clinical Aviation Medicine. 5th Ed. Castle Connelly Graduate Medical Publishing. 2006;9:251-253.
4 CMS. Transmittal 1149. 11/06/2012. Link here.
Last Updated January 28, 2021
Provided Courtesy of Waggoner Diagnostics (949) 396-1694
The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.
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