Units of Time


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

 

 

3 thoughts on “Units of Time

    • Lori, the basic issue is that there is no CPT code for optometric vision therapy (OVT). However, OVT is a direct outgrowth of orthoptics. I have reviewed this in my textbook (http://oep.excerpo.com/index.php?action=show_details&product_id=3651) showing that optometrist Louis Jaques, in his early OEP papers, used the term “Orthoptics/Re-Education”). So it is appropriate to use CPT 92065 when the therapy is orthoptic in nature, but that code is not base specified in CPT as based on timed units of therapy. This in contrast to the OT and PT codes which are. It is therefore up to the interpretation of the carrier as to whether they will honor multiple units of therapy on the same day. As noted, in our office we do 30 minute units of VT. That’s how we render it, and that’s how we bill it. If you’re with us for one hour, it’s two units. I have no clue how they would justify “intense” or “immersion” therapy for PT/OT, but not for VT.

  1. I am currently working with an insurance company in an attempt to get vision therapy covered. Our Summary Plan Document states the following: Benefits are limited to:

    90 visits/calendar year for OT and PT
    60 visits / calendar year for Speech Therapy
    20 visits per calendar year for orthoptic therapy
    limit apply to network and non network benefits combined.

    so the issue is our Optometrist office billed 1.5 hrs sessions of ftp 92065 for ICDM: 378.83. the insurance company is claiming that the maximum allowable is 1 hr per visit of CPT 92065. (and possibly further: more than 1 visit / week is not acceptable either). But my argument ( and I have had coverage from the same insurance company, 2 years prior for intensive OT that was 3 hrs/day, 5 days / week for 3 weeks). Coverage is by visits per calendar year, not by time or number of units per visit. Can you shed some light here. These vision therapy services were done in spring of 2010.

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