ExchangeCoverageMedium impact
Update to Scanning Computerized Ophthalmic Diagnostic Imaging (CP.VP.14): Effective September 1, 2026
Ambetter·GA · Ophthalmology, Optometry·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Aug 26, 2026
Summary
Ambetter from Peach State Health Plan updated its medical necessity policy (CP.VP.14) for Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) effective September 1, 2026. The policy clarifies covered indications (anterior SCODI, posterior optic nerve SCODI, posterior retinal SCODI with and without OCT angiography) and explicitly excludes coverage for advanced glaucomatous damage screening and glaucoma screening. Billing teams must ensure claims for excluded indications are not submitted or will face denials.
Action Required
By August 31, 2026: Billing team must update claim submission protocols and EMR templates to reflect the revised SCODI coverage policy. (1) Add a medical necessity checklist to encounter forms requiring providers to document which covered indication applies (anterior, posterior optic nerve, or posterior retinal SCODI). (2) Configure billing system to flag or reject claims for SCODI when diagnosis codes indicate advanced glaucomatous damage or glaucoma screening, as these are non-covered indications. (3) Educate ophthalmology providers that SCODI for glaucoma screening purposes will be denied and require alternative coding/documentation. (4) Review pending claims with DOS on or after 9/1/2026 to ensure they comply with the new policy before submission. Failure to apply these restrictions will result in claim denials from Ambetter from Peach State Health Plan.