CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI/OCT) — Posterior Segment

Policy governs coverage and use of posterior segment scanning computerized ophthalmic diagnostic imaging (optical coherence tomography) for Medicare Advantage and commercial members of Blue Cross Blue Shield - Rhode Island, describing medically necessary indications and coding guidance.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyScanning Computerized Ophthalmic Diagnostic Imaging (SCODI/OCT) — Posterior Segment

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2022

Next Review DateN/A

Key ActionFile CPT 92133 with an appropriate ICD-10 diagnosis code from the policy attachment and follow correct billing guidelines.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

92133Primary CPT code specified as medically necessary

No PA requiredPrior authorization policy

Posterior OCTImaging modality covered

May varyBenefit variation

Coverage Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Covered Indications

Posterior segment OCT is considered reasonable and necessary for the following clinical purposes:

Covered clinical purposes: Diagnose and manage medically and surgically retinal and neuro-ophthalmic diseases involving changes in the nerve, subretinal and intraretinal layers, vitreo-retinal relationships, and nerve fiber layer; differentiate causes of optic nerve disorders when the diagnosis is uncertain; diagnose early glaucoma and monitor glaucoma treatment; evaluate and manage when visual field testing is insufficient or unreliable (including when reliable visual field testing cannot be performed due to visual, physical, mental, or age-related constraints); reconcile discrepancies between clinical optic nerve appearance and visual field results; detect further loss in advanced optic nerve damage and advanced visual field loss; and follow glaucoma suspects.

Summarized from policy indications

Other indications not supported by an appropriate ICD-10 diagnosis code (see policy attachment) are considered not medically necessary and may be denied.

Use of SCODI for indications other than those paired with one of the ICD-10 diagnosis codes listed in the policy attachment is considered not medically necessary.

Provider Actions & Billing

Prior Authorization

Prior authorization is not required for SCODI/OCT services.

Note

Provider action — (placeholder)

(No additional provider-action specified.)

Billing Rule

Coding and documentation

File CPT 92133 with an appropriate ICD-10 diagnosis code from the policy attachment. Follow correct billing guidelines for global vs professional/technical component reporting when submitting claims.

CPT: 92133
See attachment for ICD-10 diagnosis codes
Bill global service or professional/technical component per standard billing rules

Denial Risk

Non-covered indications

Use of SCODI for indications other than those listed with the specified ICD-10 diagnosis codes in the policy attachment is considered not medically necessary.

Background

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI), also referred to as optical coherence tomography (OCT), is a non-invasive, non-contact tomographic imaging technique that produces high-resolution cross-sectional images of ocular structures. It permits earlier detection of optic nerve and retinal nerve fiber layer pathologic changes, assessment of retinal and choroidal layers, macular thickness, and vitreoretinal relationships, and supports diagnosis and management of retinal and neuro-ophthalmic diseases and glaucoma.

Definitions

SCODI / OCT — Definition of Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) / OCT

TermScanning Computerized Ophthalmic Diagnostic Imaging (SCODI) / Optical Coherence Tomography (OCT)

DefinitionA non-invasive, non-contact imaging technique that produces high-resolution, cross-sectional tomographic images of anterior and posterior ocular structures.

Primary clinical usesEvaluation of anterior segment and posterior segment disease, including assessment of retinal and choroidal layers, macular thickness, and vitreo-retinal relationships.

Role in glaucoma careEnables earlier detection of optic nerve and retinal nerve fiber layer pathologic changes before visual field loss, supporting diagnosis, monitoring, and initiation of therapy in glaucoma patients and suspects.

Imaging characteristicsProvides high-resolution cross-sectional images useful for discriminating among glaucoma, ocular hypertension, and normal variations; assists in surgical planning through visualization of vitreo-retinal and vitreo-papillary relationships.