CommercialCoverageMedium impact
Vision Therapy 9.01.04
Excellus BlueCross BlueShield·Ophthalmology, Optometry·Eyes (Ophthalmology)
Effective date
Nov 20, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their vision therapy policy effective November 20, 2025, clarifying that vision therapy is medically appropriate for amblyopia, acquired esotropia, and convergence insufficiency, but considers web-based/digital vision therapy programs investigational. All other vision therapy indications including learning disabilities, dyslexia, and most accommodative dysfunctions are considered investigational and likely not covered.
Action Required
By November 20, 2025: Billing team must update prior authorization requirements for vision therapy claims to align with new coverage criteria. Ensure providers document specific covered conditions (amblyopia, acquired esotropia, convergence insufficiency) and avoid billing for investigational indications like digital/web-based programs, learning disabilities, or dyslexia. Update encounter forms to reflect new coverage limitations.