Medical Policy Revision: Vision Therapy or Orthoptic Therapy for the Treatment of Visual Disorders or Learning Disabilities

Effective January 4, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for vision and orthoptic therapies for the treatment of visual disorders and/or learning disabilities.

According to the guidelines of our medical policy, Vision Therapy or Orthoptic Therapy for the Treatment of Visual Disorders or Learning Disabilities:

• Office-based vision therapy or orthoptic therapy is considered medically necessary for the treatment of the following conditions: Symptomatic convergence insufficiency; Amblyopia; or Acquired esotropia prior to surgical intervention.
• Vision therapy or orthoptic therapy is not considered medically necessary for the treatment of learning disabilities.
• Vision therapy or orthoptic therapy is considered investigational for all other conditions including, but not limited to, slow reading or to visual disorders other than those conditions noted above.

Based on the guidelines included in our revised medical policy, Vision Therapy or Orthoptic Therapy for the Treatment of Visual Disorders or Learning Disabilities AND the submitted diagnosis or diagnoses code(s), CPT® Code 92065 submitted on claims for services provided on and after January 4, 2016 may be denied as not medically necessary or as an investigational service.

Review the complete revised policy in our online Medical Policy Manual.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims submitted on and after January 4, 2016.

CPT® is a registered mark of the American Medical Association.