Does A9292 require prior authorization?

No, A9292 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A9292?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A9292`, Prescription digital visual therapy, software-only, fda cleared, per course of

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

CPT 0687T — Treatment of amblyopia using an online digital program; device supply, educational set-up, and initial session.
CPT 0688T — Treatment of amblyopia using an online digital program; device supply, educational set-up, and assessment of patient performance and program data by physician or other qualified health care professional, with report, per calendar month.

CPT 0705T — Remote treatment of amblyopia using an eye tracking device; surveillance center technical support including data transmission with analysis, with a minimum of 18 training hours, each 30 days.

Key Coverage Criteria

An initial 12-month trial of dichoptic digital therapy is consideredmedically necessarywhen the following criteria are met:
Individual is age 4 through 13 years (at least 4 years 0 days and less than 14 years old);and
The individual has anisometropic, small-angle (10 prism diopters or less) strabismic amblyopia or mixed-mechanism amblyopia;and
There is failure to respond to a 6-month trial of patching or atropine (or contraindication/allergy/intolerance to atropine);and
For CureSight and RevitalVision, the individual has passed a dedicated 10 minute in-clinic performance ability test to assure suitable eye tracking performance (validity of eye tracking data > 90% and successful calibration process);and
Myopia, if present, is not greater than -6.00 D. spherical equivalent in either eye;and

3 Active Policies

ANTHEM-CG-MED-102, Dichoptic Digital Therapy for Amblyopia

REGENCE-MED175, Digital Therapeutic Products

REGENCE-MED175.04, Digital Therapeutic Products for Amblyopia

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A9292, Prescription digital visual therapy, software-only, fda cleared, per course of