Visual Impairment Screening for Medical Diseases or Injury
DESCRIPTION
Visual impairment screening for medical diseases or injury involves any type of examination of the eyes, which is necessary in the treatment of an injury or disease.
POLICY
Screening of all children for visual or ocular disorders (e.g., pediatric amblyopia and strabismus) at each preventive care visit beginning at birth is considered medically necessary.
Vision screenings conducted by objective, standardized testing (e.g., Snellen letters, Snellen numbers, the tumbling E test, or the HOTV test) at 3, 4, 5, 10, 12, 15, and 18 years of age is considered medically necessary.
Routine screening among the elderly using Snellen acuity testing and Glaucoma testing is considered medically necessary.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Refractive examinations to determine the need for glasses and/or contacts are not considered vision screening.
SOURCES
Agency for Health Care Research and Quality. (1998). Clinicians handbook of preventive services, 2nd ed. Retrieved January 29, 2002 from http://www.ahrq.gov/clinic/ppiphand.htm.
American Academy of Pediatrics. (2003, April; reaffirmed 2007, September). Eye examination in infants, children, and young adults by pediatricians. Retrieved September 28, 2009 from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/4/902.
American Optometric Association. (2002, April). Pediatric eye and vision examination. Retrieved September 28, 2009 http://www.aoa.org/documents/CPG-2.pdf.
Simon, J., & Kaw, P. (2001). Commonly missed diagnoses in the childhood eye examination. American Family Physician, 64 (4), 623-628.
U.S. Preventive Services Task Force. (2004, May). Screening for Visual Impairment in Children Younger than Age 5 Years: Recommendation Statement. Retrieved September 28, 2009 http://www.ahrq.gov/clinic/3rduspstf/visionscr/vischrs.htm.
ORIGINAL EFFECTIVE DATE: 7/15/1976
MOST RECENT REVIEW DATE: 11/12/2009
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.