Vision Screening and Billing with Highmark Wholecare

Pediatric vision screenings identify structural abnormalities as well as visual acuity. Children who have ocular abnormalities or fail vision assessment should be referred to a pediatric ophthalmologist or appropriately trained eye care specialist.

Providers should conduct vision screenings at the following ages:

• Age 3
• Age 4
• Age 5
• Age 6
• Age 8
• Age 10
• Age 12
• Age 15

Vision Screenings for children ages 3 and below can be completed in a primary care office by testing visual acuity with age-appropriate eye charts. If a child cannot be fully screened by age 4, they should be referred to an optometrist or ophthalmologist for a full vision screening.

Instrument-based screening may be completed to detect amblyopia, strabismus, and high refractive error in children who are unable or unwilling to cooperate with traditional visual acuity screening.

Billing

All Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)  services must be reported with the age-appropriate evaluation and management code along with the EP modifier.

• 12 months to 4 years EPSDT visit CPT Code is 99382 or 99392
• 5 years to 11 years EPSDT visit CPT Code is 99383 or 99393
• 12 years to 17 years EPSDT visit CPT Code is 99384 or 99394

Providers should choose most appropriate test:

• The CPT code for Visual Acuity Screen 99173: This includes eye charts.
•  The CPT code for Instrument-based screening 99174: This is an instrument-based bilateral ocular screening with remote analysis and report.
• The CPT code for Instrument-based screening is 99177: This is an instrument-based ocular screening with on-site analysis.

Modifier 52 should be applied for a Vision Screening that may not be completed. If a screening service or component is reported with modifier 52, the provider must complete the screening service or component during the next screening opportunity according to the Periodicity Schedule.

For questions regarding the EPSDT program, please visit the American Academy of Pediatrics or contact EPSDTinfo@HighmarkWholecare.com

These codes are not all encompassing and use does not guarantee payment. They are intended as a guide to provide education around appropriate screenings and coding as part of the EPSDT program.