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.