Medicare Reimbursement for Visual Field Testing

The National Coverage Determination for computer enhanced perimetry is NCD 80.9.  Most Medicare Administrative Contractors (MACs) also publish local coverage determination (LCD) policies that supplement the NCD.

NCD 80.9 – Computer Enhanced Perimetry (Rev.1, 10-03-03) CIM 50-49 states “Computer enhanced perimetry involves the use of a micro-computer to measure visual sensitivity at preselected locations in the visual field.  It is a covered service when used in assessing visual fields in patients with glaucoma or other neuropathologic defects.”

Check your MAC’s LCD for a detailed list of covered diagnoses.

This FAQ addresses the following:

1. What is visual field testing?
2. Does Medicare cover visual field testing?
3. Does NCD 80.9 supersede information in the local policy if my MAC publishes a more detailed policy?
4. What documentation is required in the medical record to support claims for visual field?
5. Why are there three different CPT codes for visual fields, and how do you distinguish between them?
6. How much does Medicare allow for these tests, and are there limits on billing with other services?
7. Is visual field testing covered for glaucoma suspect or age-related macular degeneration (AMD)?
8. How often may visual fields be repeated on a patient?
9. If coverage of visual fields is unlikely or uncertain, how should we proceed?

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