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10.02.03 ARCHIVADA SERVICIOS DE OPTOMETRIA
SecciónPolíticas Administrativas Fecha:20 de abril de 1995
SubsecciónProfesionales Aliados a la Salud Revisión:22 de agosto de 2017
“Esta política está protegida por derechos de autor bajo las leyes federales y/o las leyes de propiedad intelectual y las de regulaciones estatales. Ninguna parte de esta publicación puede ser reproducida, almacenada en un sistema de recuperación, transmitida en cualquier forma o por cualquier medio, sea electrónico, mecánico, fotocopia, grabación o cualquier otro, sin el permiso escrito del plan de salud.”

Definición


La práctica de optometría se define como el arte y la ciencia de examinar el ojo humano y medir sus parámetros de visión utilizando distintos métodos. Incluidos entre éstos se encuentran métodos para autodeterminar la visión, el uso de artefactos computadorizados y/o automáticos para medir la refracción y otros métodos de diagnóstico para la corrección de errores de refracción.


Esta práctica no se limita a la prescripción de espejuelos y/o lentes de contacto.


Política
Se consideran para pago los servicios por optómetras para aquellas pólizas que así lo estipulen. Estos servicios no se limitarán a examinar los ojos, realizar refracciones y la prescripción de espejuelos.
Será requisito para el participante poseer la licencia estatal para la práctica de la optometría.
Códigos
CPT Description
65205 Removal of foreign body, external eye; conjunctival superficial
65210 Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjuctival, or scleral nonperforating
65222 Corneal, with slit lamp
67820 Correction of trichiaisis; epilation, by forceps only
67938 Removal of embedded foreign body, eyelid
92002 Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
92015 Determination of refractive state
92020 Gonioscopy (separate procedure)
92060 Sensorimotor examination with multiple measurements of ocular deviation (eg, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)
92065 Orthoptic and/or pleoptic training, with continuing medical direction and evaluation
92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent)
92082 Visual field examination, intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)
92083 Visual field examination, extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30°, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2)
92100 Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (eg, diurnal curve or medical treatment of acute elevation of intraocular pressure)
92225 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial
92226 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent
92250 Fundus photography with interpretation and report
92285 External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, sit lamp photography, goniophotography, setereo-photography)
92310 Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia
92311 Corneal lens for aphakia, 1 eye
92312 Corneal lens for aphakia, both eyes
92313 Corneoscleral lens
92314 Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens, both eyes except of aphakia
92315 Corneal lens for aphakia, 1 eye
92316 Corneal lens for aphakia both eyes
92317 Corneoscleral lens
92325 Modification of contact lens (separate procedure), with medical supervision of adaptation

CPT Code Deleted
CPT Description
92140 Provocative tests for glaucoma, with interpretation and report, without tonography. CPT code Deleted 12/31/2016.

La lista de códigos son los expuestos en el Manual del Optómetra.
Limitación
Según establecidas en póliza. Se cubrirán un máximo de dos visitas al año.
___________ ____________________________________
Ángela Hernández, MD Benjamín Santiago, MD
Director Médico Asociado VP Manejo Medico
Rev. 08/22/2017
05/11/2016
5/20/2013
12/21/11
09/30/10
06/03/09 (iCES)
08/29/07
12/20/04
04/20/95

Referencias

  • http://www.cms.gov/Regulations-and Guidance/Guidance/Manuals/Downloads/bp102c15.pdf

  • Current Procedural Terminology (CPT-2016) American Medical Association.