H30.133 coverage policies: Medicare and commercial payers

52 active Medicare policies list H30.133, and 5 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.

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Medicare policies listing H30.133

LCD · CGS-J15-L38992

Electroretinography (ERG)

J15 · Effective Jan 30, 2022

LCD · FIRST_COAST-L37398

Electroretinography (ERG)

J9 · Effective Feb 2, 2018

LCD · NOVITAS-JH-L37371

Electroretinography (ERG)

JH · Effective Jan 25, 2018

LCD · NOVITAS-JL-L37371

Electroretinography (ERG)

JL · Effective Jan 25, 2018

LCD · CGS-J15-L34175

Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34426

Ophthalmic Angiography (Fluorescein and Indocyanine Green)

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34426

Ophthalmic Angiography (Fluorescein and Indocyanine Green)

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33467

Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33467

Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

JM · Effective Oct 1, 2015

LCD · CGS-J15-L34399

Commercial payer policies listing H30.133

5 policies from 2 payers

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Ambetter

Ambetter policies listing H30.133, with the code’s status in each
Policy	Effective	Status of H30.133
Extended OphthalmoscopyPayerPolicy · AMBETTER-CP-VP-26	Not recorded	Covered
Fluorescein AngiographyPayerPolicy · AMBETTER-CP-VP-28	Not recorded	Covered
Fundus PhotographyPayerPolicy · AMBETTER-CP-VP-29	Not recorded	Covered
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered

UnitedHealthcare

UnitedHealthcare policies listing H30.133, with the code’s status in each
Policy	Effective	Status of H30.133
Intracanalicular and Intravitreal Corticosteroid Implants