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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Ophthalmology, OptometryMedium impact

Orthoptic Training for the Treatment of Vision or Learning Disabilities

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Orthoptic eye exercises for the treatment of learning disabilities are considered investigational, and vision therapy and orthoptics for dyslexia and other learning and reading disabilities are considered investigational. Vision therapy that involves occlusion as treatment for amblyopia, and vision therapy that involves prism adaptation before surgery for acquired esotropia, are considered medically necessary. Office-based vergence or accommodative therapy may be considered medically necessary for symptomatic convergence insufficiency if symptoms have failed to improve after a minimum of 12 weeks of home-based therapy.

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What to do

Action · 7 steps
01Billing team: Bill office-based vergence or accommodative therapy for convergence insufficiency only after at least 12 weeks of home-based therapy has failed to improve symptoms.
02Home-based therapy in the policy includes push-up exercises with an accommodative target, push-up exercises with base-out prisms, jump-to-near convergence exercises, stereogram convergence exercises, recession from a target, and maintaining convergence for 30 to 40 seconds.
03If symptoms remain after 12 weeks of orthoptic training, alternative interventions should be considered.
04Document convergence insufficiency with asthenopic symptoms at near combined with difficulty sustaining convergence, and with these findings: exodeviation at near at least 4 prism diopters greater than at far, insufficient positive fusional vergence at near (less than 15 prism diopters blur or break), a near point of convergence break of more than 6 cm, and appreciation by the patient of at least 500 seconds of arc on stereoacuity testing.
05CPT 92065 and 92066 and HCPCS V2799 are medically necessary only if the service is performed according to the Policy section.
06BCBSMS makes no payment for services that are not documented to be Medically Necessary.
07Check the member's specific benefit plan language, because the coverage guidelines should not be used in lieu of that language.

Codes mentioned

9206592066V2799H53.001H53.039H50.00H50.08H50.311H50.32H50.43H51.11Z51.89

Original notice

Orthoptic Training for the Treatment of Vision or Learning Disabilities
bcbsms.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOphthalmologyOptometryCode 92065Code 92066Code V2799Code H53.001Code H53.039Code H50.00Code H50.08Code H50.311Code H50.32Code H50.43Code H51.11Code Z51.89

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