CPT 92060, in plain terms, covers Physician examines eye alignment and deviation using multiple techniques like prism and cover testing, with written report. CPT 92060 is referenced in 2 tracked payer policy changes from Aetna Better Health of Virginia and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92060 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 92060 on AAPC
Aetna Better Health of Virginia is correcting an error that caused claims to be wrongly denied when E&M services were billed together with specific ophthalmological procedure codes. The payer has removed these codes from the denial trigger list retroactively to July 1, 2025, and will automatically reprocess all affected claims after system updates are complete by February 1, 2026.
Aetna considers up to 12 orthoptic vision therapy visits or sessions medically necessary for convergence insufficiency under plans without a vision therapy exclusion, and requests above 12 visits for this indication are subject to medical review. Members should be transitioned to a home program of exercises for convergence insufficiency, such as pencil push-ups. Eye tracking digital systems such as the CureSight System are considered medically necessary for amblyopia in a child who has tried and failed 6 months of conservative treatment, while online digital amblyopia training software, orthoptic vision therapy for other indications, RightEye Sensorimotor, and visual information processing evaluations are considered experimental, investigational, or unproven.
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