These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
Prior authorization is not required for the initial twelve (12) office visits for vision therapy / orthoptics and pleoptics.
Vision therapy or orthoptics and pleoptics is generally covered subject to the indications listed below and per your plan documents.
The physician monitoring progress may bill for a limited examination in addition to the orthoptic or pleoptic training. Document in the medical record the physician saw the member and performed the necessary procedures for a limited examination. Examinations to evaluate visual therapy are limited to one per week.
Indications that are covered
- Diagnosis and treatment of amblyopia, sensory or motor strabismus, and accommodative disorders causing subjective visual complaints which are not relieved by wearing prescription eyewear.
- Home visual therapy is to be used, including home treatment with patching, lens fogging, red/green/polaroid filters, and other lenses or devices.
- Visual therapy for amblyopia is limited to children under 10 years old. If improvement is not noted after four sessions, the member must be referred to an appropriate professional (for example, neurologist or ophthalmologist) for further evaluation.
Indications that are not covered
- Vision therapy for learning disabilities, including dyslexia.
- Services or materials that are considered experimental or not clinically proven by prevailing community standards or customary practice.
This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.