CurrentPremera BluecrossPolicy MP-072

Eye Optical Coherence Tomography (OCT)

Defines medical necessity criteria, coding, and limitations for anterior segment and related eye OCT imaging for Premera Bluecross members; intended for providers performing or requesting OCT imaging.

Policy Summary

PayerPremera Bluecross

PolicyEye Optical Coherence Tomography (OCT)

Policy CodePolicy MP-072

Change TypeNo material clinical or coverage changes

Effective DateJul 21, 2025

Next Review DateApr 1, 2025

Key ActionProvide documentation of prior refractive procedure when billing cataract codes with OCT for payment consideration.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1 CPTCPT code listed for AS-OCT

~20ICD-10 codes

2/eye/yrMax frequency for glaucoma

Not recommendedGeneral screening stance

Coverage and Medical Necessity Criteria

Medical Necessity Indications

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AS-OCT indications

Narrow angle, suspected narrow angle, or mixed narrow and open-angle glaucoma.
Determining the proper intraocular lens (IOL) for a patient who has had prior refractive surgery and now requires cataract extraction.
Iris tumor.
Presence of corneal edema or opacity that precludes visualization or study of the anterior chamber.
Calculation of lens power for cataract patients who have undergone refractive surgery.
Diagnosis of age-related macular degeneration (AMD).

This technique is not recommended for general screening of glaucoma or other retinal diseases and is not the preferred study for advanced glaucomatous damage. The policy therefore limits routine use of anterior segment OCT for broad population screening and advises selection of alternative, preferred diagnostic modalities when evaluating advanced glaucoma.

Billing Codes and Diagnosis Mapping

Covered CPT CodesCPTCovered

92132

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

Covered ICD-10 Codes (if selection criteria met)ICD-10

A18.50-A18.59	Tuberculosis of eye
H17.00-H17.9	Corneal scars and opacities
H18.10-H18.239	Corneal edema unspecified-Secondary corneal edema unspecified eye
H18.50-H18.59	Other hereditary corneal dystrophies
H21.89	Other specified disorders of iris and ciliary body
H22	Disorders of iris and ciliary body in diseases classified elsewhere
H26.041-H26.499	Anterior subcapsular polar infantile and juvenile cataract/Other secondary cataract
H26.9	Unspecified cataract
H35.30	Unspecified macular degeneration
H35.361	Drusen (degenerative) of macula, right eye

1–10 of 18

1/2

Provider Requirements, Payment Rules, and Billing Guidance

Prior Authorization

Prior Authorization Guidance

Preauthorization: The policy does not include an explicit prior authorization requirement. Coverage and payment remain subject to submission of appropriate documentation, coding accuracy, and applicable benefit limits.

No explicit prior authorization statement in policy — verify member benefits and preauthorization rules in the payer portal before scheduling.
Coverage/payment are contingent on documentation and correct coding.

Documentation Required

Prior Refractive Procedure Documentation Required

When billing cataract-related codes or other procedures affected by prior refractive surgery, documentation of the prior refractive procedure must be available in the medical record to support payment.

Applicable when cataract codes are billed alongside refractive-history–dependent services.
Include date and type of prior refractive procedure, operative note or prior procedure record, and clinical rationale linking prior refractive surgery to the current service.

Denial Risk

Payment and Bundling Limitations / Denial Risks

Provider action: submit full documentation and code to avoid denials. Be aware of specific bundling and non-payment rules described below.

Payment will not be made in addition to an A-scan or IOL master (non‑contact optical laser device).
Do not bill fluorescein angiography and OCT together unless the medical record documents the need for both on the same day.
Report services once whether performed unilaterally or bilaterally as appropriate.
Only two exams per eye per year are expected for routine glaucoma management; exceeding this without justification may risk denial.

Billing Rule

Provider Action: Indication and Documentation for Advanced Testing

High-priority provider action: ensure documentation supports medical necessity for advanced or additional testing; this technique is not appropriate for general glaucoma screening or for preferred study in advanced glaucomatous damage.

Do not use this technique as a general screening tool for glaucoma or other retinal diseases.
Document clinical indications when using for advanced glaucoma or for ordering multiple imaging modalities on the same day.

Background

Optical coherence tomography (OCT) is a noninvasive imaging technique that produces high‑resolution cross‑sectional images of ocular structures. Anterior segment OCT (AS‑OCT) is specifically used to evaluate anterior chamber anatomy and related anterior eye structures.

While AS‑OCT can be useful for targeted clinical indications, the policy clarifies limitations: it is not recommended for general screening of glaucoma or other retinal diseases and is not the preferred study for advanced glaucomatous damage.

Definitions

Anterior segment optical coherence tomography (AS-OCT)

DefinitionA non‑invasive imaging method that produces high‑resolution cross‑sectional (tomographic) views of the eye's anterior structures.

Primary clinical usesEvaluation of the anterior chamber and angle for narrow or suspected narrow angles; assessment of iris tumors; evaluation when corneal opacity or edema precludes visualization of anterior structures.

Refractive / cataract useCalculation of intraocular lens (IOL) power and determination of appropriate IOL in patients who have undergone prior refractive surgery or when standard biometry is limited.

Glaucoma roleScreening and monitoring in individuals at high risk for glaucoma and for monitoring mild to moderate glaucoma; not recommended for general population glaucoma screening.

LimitationsNot preferred for advanced glaucomatous damage and not recommended as a routine screening tool for the general population; utility may be limited when other imaging modalities are indicated.