CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI/OCT) — posterior segment

Defines medical necessity and coverage stance for posterior segment scanning computerized ophthalmic diagnostic imaging (eg, OCT) for Medicare Advantage and commercial products offered by Blue Cross Blue Shield of Rhode Island, and identifies clinical indications and applicable CPT codes.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyScanning Computerized Ophthalmic Diagnostic Imaging (SCODI/OCT) — posterior segment

Policy CodePolicy N/A

Change TypeRoutine review — no material changes

Effective DateJan 3, 2026

Next Review DateMar 1, 2026

Key ActionFile CPT code 92133, 92134, or 92137 with an appropriate ICD-10 diagnosis code when submitting claims.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3CPT codes listed as medically necessary

posterior segmentAnatomic focus

Medicare Advantage & CommercialPlan types

Coverage Criteria

Medically Necessary Indications

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Indications for posterior segment SCODI: Diagnose and manage medically and surgically retinal and neuro-ophthalmic diseases which involve changes in the optic nerve, subretinal and intraretinal changes, vitreo-retinal relationships, and changes in the nerve fiber layer.

Glaucoma detection and management: Diagnose early glaucoma and monitor glaucoma treatment; follow glaucoma suspects; allow earlier detection of glaucomatous damage to the nerve fiber layer or optic nerve and assist in estimating severity of damage.

When diagnosis is uncertain or visual field testing is limited: Differentiate causes of other optic nerve disorders when a diagnosis is in doubt; diagnose and manage the patient's condition when visual field results are insufficient or reliable visual field testing cannot be performed (eg, visual, physical, mental, or age constraints); resolve discrepancy between clinical appearance of the optic nerve and visual fields; detect further loss in advanced optic nerve damage.

Retinal disease evaluation and management: Evaluate and manage macular and other retinal disorders (including age-related macular degeneration, diabetic retinopathy, retinitis pigmentosa, uveitis, retinal detachment, and ocular tumors); detail retinal and vitreo-retinal anatomy to guide treatment and surgical planning; measure macular and retinal thickness and monitor response to therapy.

Medication toxicity monitoring: Monitor patients on long-term chloroquine or hydroxychloroquine therapy for development of retinal toxicity.

Coding and Billing

Covered CPT CodesCPTCovered

92133	Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
92134	Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; retina
92137	Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; retina, including OCT angiography

Provider Actions & Billing Rules

Prior Authorization

Prior authorization is not applicable for this policy.

Note

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Billing Rule

Billing requirement

CPT codes 92133, 92134, and 92137 must be filed with an appropriate ICD-10 diagnosis code from the attached lists. Please follow correct coding guidelines regarding filing for the global service or the professional/technical component.

92133 — OCT; optic nerve
92134 — OCT; retina
92137 — OCT; retina, including OCT angiography
File with the ICD-10 diagnosis codes listed in the attachment (separate lists per CPT code)

Note

Coverage may vary by contract

Coverage may vary between groups/contracts. Refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable diagnostic testing benefits and any limitations or non-coverage determinations.

Background

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI), commonly referred to as optical coherence tomography (OCT), is a non-invasive, non-contact tomographic imaging technique that produces high-resolution cross-sectional images of posterior ocular structures. Posterior segment SCODI/OCT captures detailed images of the retina, optic nerve, retinal nerve fiber layer, and related posterior structures to assist in the diagnosis and management of retinal and neuro-ophthalmic diseases, detect early optic nerve and nerve fiber layer changes before visual field loss, and support treatment planning and monitoring.

Definitions

Posterior segment SCODI / OCT — Imaging of the retina, optic nerve, and related posterior structures

DefinitionImaging of the retina, optic nerve, and related posterior structures producing high-resolution cross-sectional tomographic images for diagnosis and management of retinal and neuro-ophthalmic disease.

Clinical usesEarly detection of optic nerve and retinal nerve fiber layer pathologic changes prior to visual field loss; discrimination among glaucoma and non-glaucoma causes of optic nerve/IOP findings.

Retinal assessmentHigh-resolution evaluation of retinal and choroidal layers, detection of retinal edema and macular thickness measurement.

Surgical planningDisplays vitreo-retinal and vitreo-papillary relationships to assist in vitreo-retinal surgical planning and assessment.

Role in glaucoma managementEnables initiation and monitoring of therapy for glaucoma patients and glaucoma suspects before irreversible vision loss occurs.