Wow, what a slogan. You mean to tell me that the insurance company is going to help others “heal heath care”? Not in my experience. Nor that of most of my patients, frankly. Let’s take the most recent example, but first a bit more background.
The most commonly used code for optometric vision therapy is CPT Code 92065. That is orthoptics, which was the precursor of contemporary optometric vision therapy. There is no code for contemporary optometric vision therapy because medical “authorities” keep insisting that there’s not evidence that it’s efficacious beyond orthoptics. That is a specious argument as evidenced by the CITT study, where techniques were used well beyond what the conventional orthoptist or ophthalmologist employs in their offices.
Once we move beyond that, there is another aspect of code 92065 that shows a fundamental lack of understanding about vision therapy by insurance carriers. If you look at all of the analogous therapeutic codes in the 97000 series, you’ll note that they are classified by time as well as procedure, the typical unit of time being 15 minutes.
Our unit of time in vision therapy has been established in our practice as 30 minutes. That is because there are many young and/or developmentally delayed children, or patients with ABI, for whom 30 minutes of is a cognitive victory. Therefore one unit of therapy in our office is 30 minutes, and there are many patients who are in for one hour of therapy on each date of service because they’re doing two consecutive 30 minute sessions. Our rationale is the same as for every other therapeutic service that functions by timed units.
Recently we received a letter from a Medical Director of an insurance company advising us that they were only paying for one unit of therapy on any given service date because 92065 is not a timed code. I explained the rationale above but the Director wrote in her letter: “I am sorry but this is not payable. We feel the patient should not be billed, but I cannot control how an out of network physician bills a member.”
I wrote back indicating that this is not a very good way of “healing health care”, and reinforces why I am not a participating provider. As an out of network provider, I am free to do what is in the best interest of my patient without the pretense of corporate slogans.
– Leonard J. Press, O.D., FCOVD, FAAO