Currentblue cross blue shield - kansasPolicy N/A

Optical Coherence Tomography (OCT) of the Anterior Eye Segment

This Blue Cross and Blue Shield of Kansas medical policy governs coverage for scanning computerized ophthalmic imaging (e.g., anterior segment OCT) of the anterior eye segment, specifying medically necessary indications, investigational exclusions, billing guidance about concurrent procedures, and summarizes evidence, regulatory status, and rationale.

Policy Summary

Payerblue cross blue shield - kansas

PolicyOptical Coherence Tomography (OCT) of the Anterior Eye Segment

Policy CodePolicy N/A

Change TypeRevised (2018) + coding updates

Effective DateJun 1, 2021

Next Review DateN/A

Key ActionDocument the clinical indication for AS-OCT aligning with medically necessary indications: narrow/suspected narrow/mixed-angle glaucoma, iris mass, or corneal edema/opacity precluding anterior chamber visualization.

SourceLink

POLICY UPDATE CHANGES

Policy language was revised on 12-03-2018 replacing prior 'experimental/investigational' blanket statement with specific medically necessary indications and investigational exclusions.

Multiple ICD-10 codes were added and coding section updated across dates through 2024-05-13 and 2025-05-13.

Statement included that codes listed are informational and inclusion does not imply member coverage or reimbursement.

5Medically Necessary Indications Listed

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Billing Restriction (gonioscopy concurrent)

510+FDA 510(k) devices listed

manyICD-10 codes referenced

Coverage Summary

This policy covers scanning computerized ophthalmic imaging of the anterior eye segment, specifically anterior segment optical coherence tomography (AS-OCT). It defines medically necessary indications, investigational exclusions, billing guidance (including a gonioscopy concurrency rule), and summarizes evidence and device/regulatory context. The policy became effective on 2021-06-01 and was last reviewed on 2025-05-13. Coverage stance: mixed (specific indications are covered; other uses are investigational).

Key Policy Facts

Effective Date2021-06-01

Last Review2025-05-13

StatusCURRENT

SubjectAnterior segment optical coherence tomography (AS-OCT)

Scope SummaryThis BCBSKS medical policy governs coverage for scanning computerized ophthalmic imaging (eg, anterior segment OCT) of the anterior eye segment, specifying medically necessary indications (narrow/suspected narrow/mixed-angle glaucoma; iris mass; corneal edema or opacity precluding visualization; IOL calculation after prior refractive surgery), investigational exclusions for other indications, billing guidance (do not bill gonioscopy and AS-OCT concurrently for same visit/diagnosis), and coding guidance (eg, CPT 92132 when performed per policy).

Medical-Necessity Criteria

Medically Necessary Indications

Covered when ALL of the following are met:

ALL of the following

Angle assessment shows narrow anterior chamber angle (e.g., suspected or confirmed narrow angle or angle-closure on clinical exam)
Presence of an iris mass requiring noninvasive imaging for characterization or documentation
Corneal abnormality such as clinically significant corneal edema or corneal opacity that impedes adequate evaluation by slit-lamp biomicroscopy or gonioscopy

Medically Necessary Indications

Covered when ANY of the following indications are met:

ANY of the following

Investigational / Not Medically Necessary

AS-OCT of the anterior eye segment is considered experimental / investigational for indications not listed as medically necessary:

Any indication not specified under Medically Necessary Indications (eg, general anterior eye segment disease or pathology, presurgical evaluation, surgical guidance, postsurgical complications) — considered experimental/investigational unless specifically listed above

Claims for AS-OCT for indications other than the enumerated medically necessary conditions are considered experimental/investigational and may be denied.

Providers must document that AS-OCT is being used for one of the enumerated medically necessary indications (eg, narrow/suspected narrow/mixed-angle glaucoma, iris mass, corneal edema/opacity precluding anterior chamber visualization); claims for AS-OCT for indications not listed may be denied. The policy guidelines enumerate the allowed indications and include operational billing rules.

Coding

Covered CPT/HCPCSCPT|HCPCSCovered

92132

Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral

FDA product codes / device identifiers mentioned (regulatory)mixed

HLI	FDA product code referenced for several OCT devices
OBO	FDA product code referenced for several OCT devices
MXK	FDA product code referenced for some anterior segment tomography devices
HKI	FDA product code referenced for some devices
OOE	FDA product code referenced for laser systems including OCT guidance

Informational ICD-10 codes (added/updated historically)ICD-10

H40.211	Primary angle-closure glaucoma, right eye, mild
H40.212	Primary angle-closure glaucoma, right eye, moderate
H40.213	Primary angle-closure glaucoma, right eye, severe
H40.219	Primary angle-closure glaucoma, unspecified eye
H40.2210	Primary angle-closure suspect, right eye, unspecified
H40.2211	Primary angle-closure suspect, right eye, intermittent
H40.2212	Primary angle-closure suspect, right eye, chronic
H40.2213	Primary angle-closure suspect, right eye, with optic nerve damage
H40.2214	Primary angle-closure suspect, right eye, other
H40.2220	Primary angle-closure suspect, left eye, unspecified

1–10 of 32

1/4

No specific CPT/HCPCS codes listed in part 1mixed

No codes listed

Provider Actions

Documentation Required

Indication documentation

Document the clinical indication for AS-OCT in the medical record. Required documentation should align with the policy's medically necessary indications and support that the study is being performed for one of those indications.

Narrow angle, suspected narrow angle, or mixed narrow and open angle glaucoma
Iris mass
Presence of corneal edema or opacity that precludes visualization or study of the anterior chamber
Determination of proper intraocular lens power for patients who have had prior refractive surgery (with additional documentation of the prior refractive procedure)

Documentation Required

Document prior refractive surgery for IOL calculation

When AS-OCT is used to determine intraocular lens power for a patient who has undergone prior refractive surgery, additional documentation of the prior refractive procedure must be available in the medical record as described in the Policy Guidelines.

Background and Evidence

Anterior segment OCT (AS-OCT) is a noninvasive, high-resolution imaging modality that creates cross-sectional images of anterior ocular structures using interferometry and reflected light. It is evaluated for diagnosing angle-closure glaucoma, presurgical evaluation, surgical guidance, postsurgical complication assessment, and imaging anterior segment pathology.

Alternatives include gonioscopy and slit-lamp biomicroscopy (with specialized lenses), Scheimpflug imaging, and ultrasound biomicroscopy (UBM); AS-OCT offers higher optical resolution and does not require probe placement under topical anesthesia, while UBM and ultrasound may better visualize some posterior/anatomic structures and require contact. AS-OCT has been used intraoperatively and postoperatively (eg, visualization of aqueous tube shunts and detection of graft detachment) and can provide added diagnostic information in certain surgical contexts.

Definitions

Thresholds / Measurements

Studies report quantitative angle metrics with angle opening distance measured at 250, 500, and 750 μm from the scleral spur (AOD250, AOD500, AOD750) and these measurements are commonly used in diagnostic studies. The policy notes AOD measurements at 250, 500, and 750 μm are used in the literature but does not mandate a specific numeric cutoff for coverage decisions.

Evidence also highlights image-quality limitations: a substantial proportion of eyes in screening studies could not have the scleral spur identified or were excluded for poor image quality (eg, inability to locate the scleral spur in roughly 25% of participants), which can limit use of AOD measurements and quantitative assessment.

Revision History

2018-12-03policy_revision

Policy language revised: removed prior blanket 'experimental/investigational' statement and replaced it with specific medically necessary indications including narrow angle (and suspected/mixed narrow and open angle glaucoma), determination of proper intraocular lens for patients with prior refractive surgery, iris mass; effective date 12-03-2018.

2019-04-24policy_update_coding

Policy updated to add medically necessary indications including presence of corneal edema/opacity and calculation of lens power for cataract patients post-refractive surgery; Policy Guidelines added; ICD-10 codes were added to the coding section.

2021-06-01

Policy Summary

Payerblue cross blue shield - kansas

PolicyOptical Coherence Tomography (OCT) of the Anterior Eye Segment

Policy CodePolicy N/A

Change TypeRevised (2018) + coding updates

Effective DateJun 1, 2021

Next Review DateN/A

SourceLink

On This Page

Evaluation of anterior chamber angle anatomy when gonioscopy is inconclusive, not tolerated, or technically not feasible

Preoperative assessment for anterior segment surgery when high-resolution imaging is required for surgical planning (e.g., assessment of corneal thickness, anterior chamber depth, or angle anatomy)

Postoperative evaluation to assess complications following anterior segment surgery (e.g., tube shunt blockage, Descemet membrane detachment)

Imaging for anterior segment pathologies where cross-sectional high-resolution imaging provides clinically useful information (e.g., corneal lesions, anterior tumors, noninfectious uveitis)

Measurement or imaging needed to assist intraocular lens (IOL) power calculation in eyes with prior refractive surgery or other corneal alterations where standard biometry is unreliable

Threshold: use when alternative validated methods are insufficient for IOL calculation

Billing Guidance

Billing and operational guidance:

ALL of the following

Do not bill anterior segment OCT at the same encounter for the same indication as gonioscopy; these are alternative means of angle assessment and simultaneous billing may be inappropriate.
If both procedures are performed, document medical necessity for each and the distinct clinical rationale.

Investigational / Experimental (Not Covered)

Not covered (Investigational / Experimental):

ANY of the following

Use of anterior segment OCT for routine screening in asymptomatic individuals without clinical signs or risk factors for anterior segment disease or angle-closure glaucoma
Use of anterior segment OCT for indications where there is insufficient evidence of clinical benefit compared with standard diagnostic methods (e.g., routine replacement of established diagnostic techniques without specific clinical justification)
Any use of anterior segment OCT considered experimental, investigational, or unproven by current evidence for the specified clinical situation

Billing Rule

Concurrent billing restriction

Do not bill both gonioscopy and anterior segment OCT concurrently at the same visit with the same diagnosis.

Billing Rule

Use CPT 92132 for anterior segment OCT

Report anterior segment OCT using CPT/HCPCS code when applicable; coverage applies only when performed per the Policy.

92132
Coverage of this code is medically necessary ONLY when the procedure is performed according to the Policy section

Prior Authorization

Verify member benefits

Refer to the member's contract benefits in effect at the time of service to determine coverage. Contact Blue Cross and Blue Shield of Kansas Customer Service for verification of individual member benefits.

Denial Risk

Not covered for non-listed indications

Claims for AS-OCT for indications other than the enumerated medically necessary conditions are considered experimental/investigational and may be denied.

policy_effective_date_coding

Policy current effective date noted as 06-01-2021; ICD-10 codes continued to be added/updated in coding section and Policy Guidelines maintained.

2022-05-04coding_update

ICD-10 codes were added and coding section was updated; at one point ICD-10 codes were converted to code ranges.

2022-07-01coding_update

Coding section updated to add CPT temporary code 0730T.

2023-04-25coding_update

Coding section revised: ICD-10 codes added/updated; subsequent edit removed ICD-10 codes and removed CPT 0730T per the coding history entries.

2024-04-23coding_update

Coding and references updated with added ICD-10 codes and Policy Guidelines reiterated; description and rationale sections updated.

2025-05-13policy_review_and_codingLatest

Latest review dated May 13, 2025: coding section and references updated with added ICD-10 codes; Policy Guidelines and medically necessary indications (including corneal edema/opacity and prior refractive surgery IOL calculations) maintained; note that inclusion of codes is informational and codes are medically necessary only if performed per the Policy section.