Audience: Participating Physicians
Univera Healthcare will implement a new administrative policy effective April 15, 2020, which defines coverage and billing guidelines for visual screening services.
The policy aligns with Bright Futures recommendations and will apply to the following lines of business: Commercial (HMO, PPO, POS, Federal Employee Plan (FEP) and indemnity), and New York State Government Programs (Medicaid Managed Care, Health and Recovery Plan (HARP), Child Health Plus (CHP) and Special Programs (Essential Plan and Healthy NY).
Administrative Policy 25 – Visual Screening Services
- The Health Plan will consider visual function screening, CPT® 99172 inclusive when billed with an Evaluation and Management (E&M) code.
- For members aged 18 and younger, the Health Plan will reimburse CPT 99173, 99174, and 99177, when billed with a Preventive Medicine Evaluation and Management (E/M) code.
- For members aged 19 and older, the Health Plan considers CPT codes 99173, 99174, and 99177, inclusive when billed with a Preventive Medicine Evaluation and Management (E/M) code.
This policy will be reviewed pre-payment. Pre-payment review means claims are reviewed prior to payment. A pre-payment review results in an initial determination.
These services are subject to audit and policy updates at Univera Healthcare’s discretion. Members are held harmless for all denials resulting from this administrative policy. You can access the individual policies on our website, UniveraHealthcare.com/Adminpol. Note: You must login with your username and password to access our administrative policies.
If you are not currently registered to view the secure section of our website, we encourage you to register today at Provider.UniveraHealthcare.com.
If you need assistance registering, contact the Web Security Help Desk at 1-800-278-1247. In addition, your Provider Relations representative is available to assist with website registration and functionality training.
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