Confirm product-specific prior authorization and benefit rules

This policy applies only to certain Capital Blue Cross programs and products; benefit variations may affect prior authorization requirements and coverage determinations. Refer to product-specific guidance (including FEP PPO instructions) when requesting prior authorization.

• Policy applicability may vary by product.
• FEP PPO members: follow FEP medical policy manual at fepblue.org.

Do not expect coverage for investigational procedure codes (e.g., 92132)

Procedure code 92132 for anterior segment OCT is listed as investigational and therefore not covered; claims submitted with this code may be denied regardless of prior authorization.

• Investigational procedure code identified: 92132.
• Investigational designation means the code is not payable under this policy.

Consider established alternatives (gonioscopy or ultrasound) first

Before ordering AS-OCT, document that established alternative exams (slit-lamp biomicroscopy with gonioscopy or ultrasound biomicroscopy) were considered or are not appropriate for the clinical question.

• Slit-lamp biomicroscopy with gonioscopic mirror is the typical evaluation method for the anterior chamber angle.
• Ultrasound biomicroscopy is an alternative imaging method with known resolution characteristics.

Document clinical intent and expected impact on care

Ensure clinical indications, test purpose, and how the AS-OCT findings will affect management are documented in the medical record to support medical necessity and claims processing.

• Record the clinical indication and intended use (e.g., evaluation for angle‑closure, presurgical assessment, surgical guidance, or postsurgical complication assessment).
• Policies are not guarantees of coverage; payment depends on member benefits and medical necessity determinations.

Document clear clinical indication and intended use

Document the specific clinical indication and intended use for AS-OCT (for example: evaluation for angle‑closure glaucoma, presurgical assessment for anterior segment surgery, intraoperative or surgical guidance, or evaluation of postsurgical complications).

• Indications cited in policy include evaluation for angle‑closure, presurgical/planned anterior eye surgery evaluation, surgical guidance, and postsurgical complication assessment.
• Include how results will change patient management to support necessity.

Verify member benefits and document medical necessity

Confirm member benefit terms and eligibility before billing; this policy does not guarantee coverage or payment and final claim processing depends on the member’s contract and medical necessity determinations.

• Policies are used to determine coverage but are not guarantees of payment.
• Payment is subject to member benefit program terms, eligibility, and medical necessity.

Risk of denial: AS‑OCT considered investigational for anterior eye

Be aware AS‑OCT may be denied as investigational; the evidence is considered insufficient to conclude AS‑OCT improves health outcomes, so prior authorization may be declined or claims denied.

• Policy states AS‑OCT of the anterior eye is investigational due to insufficient evidence of benefit.
• Diagnostic accuracy data exist but linkage to improved outcomes is not established, supporting denial risk.

Investigational procedure codes (92132) likely denied

Claims for services billed with investigational procedure codes (notably CPT code 92132) may be denied because the policy lists these codes as investigational and not covered.

• Procedure code 92132 is explicitly listed as investigational and therefore not covered.
• Coding lists may not be all‑inclusive; verify current coding guidance and member benefits.