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Orthoptic training, as defined by CPT® Code 92065, involves individualized sessions aimed at enhancing the function of the eye muscles. This training is typically conducted by a physician or another qualified healthcare professional who prescribes specific exercises designed to improve visual tracking and address various ocular issues. Common conditions that may necessitate orthoptic training include amblyopia, which is characterized by reduced vision in one eye due to abnormal visual development, and strabismus, a condition where the eyes do not properly align with each other. Additionally, orthoptic training is beneficial for patients with defects in binocular vision, such as convergence insufficiency, where the eyes struggle to turn inward when focusing on nearby objects, and convergence excess, which is the opposite condition. The physician evaluates the patient's needs and determines the most suitable eye exercises, providing training to ensure the patient can effectively perform the therapy. A diverse range of techniques and tools may be utilized during these sessions, including prisms, pencil push-ups, specially tinted lenses, color cards, penlights, mirrors, video games, and tracing pictures. While some aspects of the visual therapy may take place in the office setting, patients may also be assigned exercises to practice at home. It is important to report CPT® Code 92065 when the training is conducted by a physician or qualified professional, whereas CPT® Code 92066 should be used when the training is performed under their supervision.
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Orthoptic training is indicated for various ocular conditions that affect eye muscle function and visual coordination. The following conditions may warrant the need for this specialized training:
The procedure for orthoptic training involves several key steps that are designed to enhance the patient's eye muscle function and visual coordination. Each step is tailored to the individual needs of the patient based on their specific ocular condition.
After completing the orthoptic training sessions, patients may experience improvements in their eye muscle coordination and visual tracking abilities. It is essential for patients to adhere to any prescribed home exercises to maximize the benefits of the training. Follow-up appointments may be scheduled to monitor progress and make any necessary adjustments to the training plan. The physician will assess the effectiveness of the exercises and determine if further sessions are needed or if additional interventions are required to address any remaining visual issues.
| Short Descr | ORTHOP TRAING PFRMD PHYS/QHP | Medium Descr | ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP | Long Descr | Orthoptic training; performed by a physician or other qualified health care professional | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 2 - 150% payment adjustment does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Not Billable to the MAC | Type of Service (TOS) | Q - Vision Items or Services | Berenson-Eggers TOS (BETOS) | M5C - Specialist - ophthalmology | MUE | 1 | CCS Clinical Classification | 220 - Ophthalmologic and otologic diagnosis and treatment |
| GA | Waiver of liability statement issued as required by payer policy, individual case | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GP | Services delivered under an outpatient physical therapy plan of care | GT | Via interactive audio and video telecommunication systems | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | KX | Requirements specified in the medical policy have been met |
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| 2023-01-01 | Changed | Code description changed. |
| 2022-01-01 | Changed | Code description changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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