Eye Optical Coherence Tomography
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Defines medical necessity criteria and coding for anterior segment (AS‑OCT), posterior segment (PS‑OCT), and OCT angiography (OCT‑A) imaging of the eye for Premera members; intended for providers assessing coverage for OCT services.
AS-OCT may be used as an adjunctive imaging tool to evaluate anterior segment structures or implanted IOL pathology when clinically indicated, including members now requiring cataract extraction.
Title changed from Eye-Anterior Segment Optical Coherence Tomography to Eye-Optical Coherence Tomography.
Limitations and references were updated; no other policy statements changed.
Coverage and Medical Necessity Criteria
AS-OCT Medical Necessity
Covered when ANY of the following are met for AS-OCT:
Added/clarified in 08/01/26 review
PS-OCT Medical Necessity
Covered when ANY of the following are met for PS-OCT:
OCT-A Medical Necessity
Covered when ANY of the following are met for OCT-A:
This imaging modality is not recommended for routine population screening of glaucoma or other retinal diseases. The policy specifies that OCT is not the preferred study for eyes with advanced glaucomatous damage, where management relies primarily on visual field testing and other structural assessments.
Fluorescein angiography and optical coherence tomography will not be covered on the same day unless the clinical record clearly documents a medical need for both procedures performed the same day.
Use of OCT for general population screening of glaucoma or retinal diseases is explicitly limited and not recommended by this policy.
Coding and Frequency Guidance
| 92132 | Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral. |
| 92133 | Computerized ophthalmic diagnostic imaging (e.g., optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; optic nerve. |
| 92134 | Computerized ophthalmic diagnostic imaging (e.g., optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; retina (including OCT angiography). |
| A18.50-A18.59 | Tuberculosis of eye. |
| H16.9 | Corneal scars and opacities. |
| H18.8 | Other hereditary corneal dystrophies. |
| H18.9 | Corneal edema unspecified. |
| H21.89 | Other specified disorders of iris and ciliary body. |
| H22 | Disorders of iris and ciliary body in diseases classified elsewhere. |
| H26.9 | Unspecified cataract. |
| H35.30 | Unspecified macular degeneration. |
| H35.361 | Drusen (degenerative) of macula, right eye. |
| H35.362 | Drusen (degenerative) of macula, left eye. |
Provider Requirements and Billing Guidance
Use listed CPT codes and meet cataract documentation conditions
Covered CPT codes for OCT imaging with interpretation and report are 92132 (anterior segment), 92133 (posterior segment; optic nerve), and 92134 (posterior segment; retina). For cataract-related OCT codes, payment will only be made if additional documentation of a prior refractive procedure is present in the patient record; payment will not be made in addition to an A‑scan or IOL master. The policy does not state a separate prior authorization requirement for these codes.
- 92132 — Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral.
- 92133 — Computerized ophthalmic diagnostic imaging (e.g., OCT), posterior segment; optic nerve, with interpretation and report, unilateral or bilateral.
- 92134 — Computerized ophthalmic diagnostic imaging (e.g., OCT), posterior segment; retina, with interpretation and report, unilateral or bilateral.
- Cataract-related OCT payment requires documentation of prior refractive procedure; not payable with A‑scan or IOL master.
Schedule follow-up about two exams per eye per year; adjust for risk
Follow-up imaging is generally performed at intervals consistent with approximately two exams per eye per year for glaucoma management; more frequent testing may be required for progression or higher risk.
- Plan surveillance around ~2 exams per eye per year for typical glaucoma monitoring.
- Increase testing frequency if clinical progression or higher risk is documented.
Document prior refractive procedure for cataract-related OCT payment
For cataract-related OCT billing, include additional documentation in the patient record of the prior refractive procedure; without that documentation payment for the cataract codes will not be made.
- Document prior refractive procedure in the chart when reporting cataract-related OCT codes.
- Do not expect payment for these codes when an A‑scan or IOL master is also billed for the same service.
Avoid same-day FA and OCT unless chart documents need
Fluorescein angiography and OCT will not be covered on the same day unless the medical record documents the need for both procedures.
- If both tests are clinically necessary the chart must explicitly document the need for same-day performance to avoid denial.
Background
Optical coherence tomography (OCT) is a noninvasive imaging technique that produces high-resolution cross-sectional views of ocular structures. OCT may be used to image both the anterior segment (for example, cornea, iris, anterior chamber angle, and implanted intraocular lenses) and the posterior segment (including the macula, retina and optic nerve head) to evaluate structural pathology.
Definitions
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