Use CPT 92081–92083; repeated testing beyond policy limits may be denied

Report visual field examinations with CPT codes 92081, 92082, and 92083; coverage is limited to the medical indications listed in the policy and repeated testing beyond policy frequency limits (for example, more than twice per year for controlled glaucoma) may be considered not medically necessary and denied.

• Use CPT 92081, 92082, or 92083 with interpretation and report as applicable.
• Services must meet one of the medically necessary indications listed in the policy to support coverage.
• Repeated routine testing exceeding policy limits (e.g., >2/year for controlled glaucoma) may be denied.

No prior authorization specified in this segment

This document segment does not state any prior authorization requirement for visual field testing; it provides diagnosis code listings that may support medical necessity.

Prior authorization not specified

No prior authorization requirements are specified in the provided text for reporting visual field examinations.

Provide an appropriate ICD-10 diagnosis from the listed codes

This excerpt contains ICD-10 diagnosis codes that are used to support medical necessity for visual field testing; check other policy sections for any explicit prior authorization rules.

No prior authorization rules in this segment

No prior authorization rules are stated in this portion of the policy; the content provided is diagnosis code listings rather than authorization criteria.

Prior authorization not specified here

No prior authorization requirements are stated in the chunks covered by this segment.

Verify program‑specific coverage rules (Medicaid/Medicare)

For Medicaid members, state Medicaid coverage provisions take precedence over this clinical policy; for Medicare members, review applicable Medicare NCDs and LCDs prior to applying the policy criteria.

• Verify state Medicaid manual provisions for Medicaid members.
• Check relevant Medicare NCDs/LCDs and Coverage Articles for Medicare members.

No step therapy requirements in this segment

No step therapy requirements are included in this code‑list segment of the policy.

Report CPT 92081–92083 with interpretation/report and supporting documentation

Report visual field examinations with CPT codes 92081, 92082, or 92083 and include interpretation and a report; ensure clinical documentation supports the chosen ICD-10 diagnosis used to substantiate medical necessity.

• Include interpretation and a formal report when submitting CPT 92081–92083.
• Document clinical indication and the specific ICD-10 diagnosis code from the policy to substantiate medical necessity.

ICD-10 codes provided to support claims; no template specified

The code lists provide ICD-10 diagnosis codes that may be used to support claims, but this segment does not include a required documentation template.

Use provided ICD-10 codes to support medical necessity

The ICD-10 diagnosis codes and descriptions in this segment may be used to support medical necessity for visual field testing when billed.

Include a specific ICD-10 diagnosis from the policy on the claim

Include the specific ICD-10 diagnosis code from the provided list (for example H21.*, H30.*, H33.*, H34.*, H35.*, H40.*) on the claim to substantiate medical necessity for visual field testing.

• Select the most specific ICD-10 code from the policy's lists to match the clinical indication.
• Ensure the claim diagnosis matches documented clinical findings in the patient record.

ICD-10 code listings available to support documentation

This segment provides ICD-10 diagnosis codes and descriptions that may be used to support documentation for visual field testing claims.

Use ICD-10 descriptions to align billing with clinical indication

ICD-10 codes with descriptions in this segment may be used to support medical necessity when billing for visual field testing; ensure the chosen code aligns with the documented clinical indication.

Follow Health Plan administrative policies and document clinical indications

Providers must follow Health Plan‑level administrative policies and procedures and document clinical indications consistent with this policy and the member's coverage documents.

• Maintain clinical records documenting the indication for testing.
• Follow Health Plan administrative submission rules when filing claims.

Denial risk for repeated testing / >2 tests/year for controlled glaucoma

Repeated testing for a stable, diagnosed condition or testing that exceeds twice per year for controlled glaucoma is considered not medically necessary and may result in claim denial.

• Avoid routine repeat visual field tests for stable conditions without documented clinical change.
• Limit routine testing for controlled glaucoma to no more than twice per year unless clinical justification is documented.

Diagnosis codes listed; no authorization language here

This chunk contains diagnosis codes rather than explicit authorization or denial language; refer to other policy sections for authorization details.

Code listings only — no authorization triggers shown

No explicit authorization or denial triggers are present in these code listing chunks; they list ICD-10 diagnosis codes and descriptions only.

Claims risk if an appropriate ICD-10 diagnosis is not present

Absence of an appropriate ICD-10 diagnosis from the listed ophthalmic codes may fail to support medical necessity and could lead to claim denial.

• Ensure the claim includes an ICD-10 code from the policy list that matches the documented clinical indication.

No authorization-specific denial triggers in code list

This portion contains diagnosis code listings only and does not present authorization-specific denial triggers.

Diagnosis code list only — no explicit authorization language

This part of the policy contains ICD-10 diagnosis code lists without explicit authorization or denial language.

Coverage decisions subject to plan terms; out-of-scope services may be denied

Coverage decisions are subject to all terms, conditions, exclusions and limitations of the member's coverage documents; services outside those terms may be denied.

• Confirm member eligibility and benefit limits before performing tests.
• Claims for services that fall outside coverage documents may be denied.