95930_R37

This Medicare carrier does not have a local coverage determination (LCD) for this particular diagnostic test.  The policy presented is to serve as a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.  

1.   All documentation should be maintained in the patient’s medical record and made available to the contractor upon request.

2.  Every page of the record should be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)).  The documentation should include the legible signature of the optometrist or ophthalmologist responsible for and providing the care to the patient.

3.  The submitted medical record should support the use of the selected ICD-10-CM code(s).  The submitted CPT/HCPCS code should describe the service performed.

4.  The medical record documentation should support the medical necessity of the services as directed in this policy.

5.  The patient’s medical record should contain documentation that fully supports the medical necessity for NEPs as covered by Medicare.  This documentation includes, but is not limited to, relevant medical history, physical examination and results of pertinent diagnostic tests or procedures.

1.  Report a VEP with CPT code 95930.  This is a bilateral test, therefore no modifiers are required if both eyes are examined.  A unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.

2.  A VEP test is usually reported globally, but it may be separated into a professional component (modifier -26 and a technical component (modifier -TC) if necessary.

3.  VEP test can be done with general or direct supervision by the optometrist/ophthalmologist depending on if the technician is certified or non-technicians are now able to become certified by the American Board of Physical Therapy Specialties (ABPTS) to perform sensitive and complex neurophysiological studies.  If your technician is certified, a VEP test may be performed under general supervision (the doctor is not immediately available).  If your technician is not ABPTS certified, a VEP test must be performed with direct supervision (doctor is immediately available).

4.  An eye examination may be reported on the same day as a visual evoked potential test if it is medically necessary.

In general, VEP testing is reimbursed when it is reasonable and medically necessary.  Since there are no published utilization guidelines for VEP testing, doctors should adhere to CMS Ruling 95-1 (V) which states that utilization of VEP testing should be consistent with locally acceptable standards of practice.

According to the International Society for Clinical Electrophysiology of Vision, a minimum of two VEP recordings should be acquired, measured, and displayed to confirm the reproducibility of data if the findings are abnormal.  Also, it is usually not medically necessary to perform more than two VEP tests in a twelve-month period to diagnose and treat optic nerve disease.