Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2018

Coverage of Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)


Harvard Pilgrim has created a new medical policy for the management of scanning computerized ophthalmic diagnostic imaging (SCODI) — which includes confocal laser scanning ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography — effective for commercial members for dates of service beginning July 1, 2018.

SCODI can be used to assess the presence and progression of glaucoma and retinal disorders, as well as certain disorders of the anterior eye. The new medical policy outlines the specific indications and criteria for which SCODI is considered medically necessary and eligible for reimbursement.

For our commercial members, Harvard Pilgrim will cover the following CPT codes only when they are submitted with certain diagnosis codes (a complete list of these codes is attached to the new medical policy) and all the criteria indicated on the policy are met:

  • 92132 – Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
  • 92133 – Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
  • 92134 – Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina

Prior authorization is not required. For complete information, please refer to Harvard Pilgrim’s Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) Medical Policy.

    Email this article to a colleague   


    Network Matters Archives

    Download printer-friendly version

    HPHCURRENT EVENTS

    Sign Up for a Webinar on Our Genetic Testing Program

    CLINICIAN CORNER

    Decreasing Preventable ED Visits and Hospital Readmissions

    Coverage of Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

    Prior Authorization Required for Brineura

    Prior Authorization Criteria Updated for Xgeva

    Mental Health Month and Alternative Health Benefits

    OFFICE ASSISTANT

    Reminder: Report Condition and Value Codes on Institutional Claims

    Update to Reimbursement of Codes With PC/TC Indicator of 3

    Reimbursement of 3D Rendering of Imaging Studies

    Correct Usage of Modifiers LT, RT, and 50

    PUBLICATION INFORMATION

    Eric H. Schultz,
    President and Chief Executive Officer

    Robert Farias,
    Senior Vice President, Corporate Network Strategy

    Annmarie Dadoly,
    Editor

    Joseph O'Riordan,
    Writer

    Kristin Edmonston,
    Production Coordinator