Reimbursement for Perimetry with Ceeable Visual Field Analyzer

FREQUENTLY ASKED QUESTIONS:

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Q: What is the Ceeable Visual Field Analyzer?

A: The Ceeable Visual Field Analyzer is a tablet-based perimeter that runs cloud-based software and utilizes contrast sensitivity to test central visual fields. The test looks like an Amsler grid to the patient. A darkened room is required for each test session.

Q: How does the Ceeable perimeter work?

A: Ceeable notes, “With one eye covered, a patient is positioned on a chin/head rest in front of a tablet computer. The patient is then instructed to ‘finger-trace’ areas of a dynamically generated grid (on the tablet) that are missing from their field of vision or appear to be distorted. The grid is then presented … at different greyscale levels … As the greyscale level is decreased … defects become … easier to detect. Upon completion of the test, the patient’s finger-traces are translated into a three-dimensional topographical contour map that represents their ‘hill-of-vision’. An integrated auto-characterization system then objectively characterizes the occurring visual field defects…”

The test has been evaluated in the US military and on NASA astronauts. It takes about 4 minutes per eye to perform the test and it has a spatial resolution of about 1 degree.

Q: Who is a candidate for the Ceeable Visual Field Analyzer?

A: Patients who can follow instructions for visual field testing with a tablet, and have suspected optic nerve, visual pathway, or retinal disease, may be candidates this test.

Q: Do Medicare and other third party payers cover visual field testing?

A: Yes, when medically necessary. The National Coverage Determination (NCD) for computer enhanced perimetry, §80.9, states, “Computer enhanced perimetry involves the use of a micro-computer to measure visual sensitivity at pre-selected locations in the visual field. It is a covered service when used in assessing visual fields in patients with glaucoma or other neuro-pathologic defects.” Most Medicare Administrative Contractors (MACs) also publish local coverage determination (LCD) policies that supplement but do not over-rule the NCD; check your local policies.

Q: How do we report perimetry performed in a physician’s office with the Ceeable Visual Field Analyzer?

A: Use CPT 92082 (Visual field examina-tion, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least two isopters on Goldman perimeter, or semi-quantita-tive, automated suprathreshold screening program).

Q: What documentation is required in the medical record to support claims for visual fields?

A: A physician’s interpretation and report is required. A brief notation such as “abnormal” does not suffice. In addition to the fields, the medical record should include:

order for the test with medical rationale
date of the test
the reliability of the test (e.g., poor patient cooperation)
test findings (e.g., scotoma)
comparison with prior tests (if applicable)
a diagnosis (if possible)
the impact on treatment and prognosis
physician’s signature

Q: Do Medicare and other third party payers cover self-administered, home perimetry?

A: No. All MACs, except Palmetto GBA, list this test as not covered.¹ Palmetto GBA covers it, but only in an Independent Diagnostic Testing Facility (IDTF) setting under direct supervision.² Ceeable does not use an IDTF so this does not apply. Aetna, a non-Medicare payer, does not cover home testing.³ The patient is financially responsible for the service.

Q: Are there different CPT codes for home perimetry?

A: Yes. There are two Category III CPT codes.

0378T – Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional.

0379T – Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; technical support and patient instructions, surveillance, analysis, and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional.

Code 0378T describes physician work and 0379T describes the web application, surveillance center, and web portal. These codes are distinguished from each other by the relevant service provider: respectively, the physician and the surveillance center.

Q: If coverage of perimetry is unlikely or uncertain, how should we proceed?

A: Explain why visual field testing is necessary, and that Medicare or other third party payer will likely deny the claim. Ask the patient to assume financial responsibility for the charge. A financial waiver can take several forms, depending on insurance.

An Advance Beneficiary Notice of Noncoverage (ABN) is required for services where Part B Medicare coverage is ambiguous or doubtful, and may be useful where a service is never covered. You may collect your fee from the patient at the time of service or wait for a Medicare denial. If both the patient and Medicare pay, promptly refund the patient or show why Medicare paid in error.
For Part C Medicare (Medicare Advantage), determination of benefits is required to identify beneficiary financial responsibility prior to performing noncovered services. MA Plans have their own waiver processes and are not permitted to use the Medicare ABN form.
For commercial insurance beneficiaries, a Notice of Exclusion from Health Plan Benefits (NEHB) is an alternative to an ABN.

¹ National Government Services. Category III codes. L33392. Rev. 01/01/18. Link here. Accessed 04/11/18.
² Palmetto GBA. IDTF Table. Updated 03/29/18. Link here. Accessed 04/11/18.
³ Aetna. Age-Related macular Degeneration. Policy 0765. Last reviewed 11/28/17. Link here. Accessed 04/11/18.

Provided courtest of Ceeable, Inc.

Last updated May 7, 2018

The reader is strongly encouraged to review federal and state laws, regulations, code sets (including ICD-10), and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. 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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