PA Lookup

Visual Evoked Potential (VEP) test is a diagnostic tool for the neurological assessment of the visual system. VEP measures the time it takes for nerves to respond to stimulation. The size of the response is also measured. During the VEP test, the eyes are stimulated by looking at a test pattern. Each type of response is recorded from brain waves by using electrodes taped to the head. The VEP test is the most commonly used evoked potential test in the diagnosis of multiple sclerosis (MS). Interpretation is provided by neurologists, physiatrists, ophthalmologists or optometrists specially trained or skilled in VEP testing. The VEP test involves a flashing stroboscope or viewing a black and white checkered pattern on a television (TV) monitor in a darkened room. The black and white squares alternate on a regular cycle which generates electrical potentials along the optic nerve and into the brain producing wave patterns that are recorded. These are detected with electroencephalographical (EEG) sensors placed at specific sites on the back of the head (the occipital scalp). Each eye is tested independently while an eye patch is worn on the other eye. VEPs are very sensitive at measuring slowed responses to visual events and can often detect dysfunction which is undetectable through clinical evaluation and the person is unaware of any visual defects. Because of their ability to detect silent lesions and historic demyelinating episodes, they are very useful diagnostic tools. A definite diagnosis of multiple sclerosis requires at least two distinct demyelinating episodes, in two different central nervous system sites which are separated by at least one month (the Schumacher criteria). VEPs can often provide evidence of such episodes when other tests, even MRI, cannot.

Unit Value

1 unit per test

Limits

VEP is considered experimental and investigational if the Clinical Coverage Policy eligibility criteria are not met (section 2.0 and 3.0)

Exclusions

Medicaid does not cover VEP as a routine screening tool to meet the requirements of vision screening during an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) exam. However, if during an EPSDT exam the physician documents a medical need for additional vision services, (i.e. an abnormality is suspected) the physician is expected to make the appropriate referral for a more formal vision assessment. Physicians providing children’s vision assessments shall follow the American Academy of Pediatrics policy for “Eye Examination in Infants, Children, and Young Adults by Pediatricians.”

Place of Service

Inpatient, Outpatient, Office and Independent Diagnostic Testing Facilities (IDTF)

Additional Service Specifics

Use modifier 26 when billing the professional component. Use modifier TC when billing the technical component.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-28
• Records Management and Documentation Manual

How to Submit

N/A - No authorization is required

How to Submit

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How to Submit

N/A - No authorization is required

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N/A - No authorization is required

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N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

Diabetes outpatient self-management education (DSME) is an interactive, ongoing process of teaching the knowledge, skills and abilities needed for diabetes self-care. The process combines the needs, goals, and life experiences of the diabetic beneficiary and certified diabetes educator(s) and is guided by evidence-based standards. This process includes: a. Assessment of the individual’s specific education needs; b. Identification of the individual’s specific diabetes self-management goals; c. Education and behavioral intervention directed toward helping the individual achieve identified self-management goals; d. Evaluation of the individual’s attainment of identified self-management goals.

Unit Value

1 unit = 30min

Limits

Physician certification is required. A physician referral will meet this qualification. A prescription signed by the referring physician will suffice as certification. Initially, up to 10 hours of DSME is covered within a continuous 12-month period (not necessarily within the same calendar year). DSME may be offered in any combination of individual or group counseling. For follow-up training, a maximum of 2 hours of training is covered each year, starting with the calendar year in which the beneficiary receives the initial training, in any combination of individual or group counseling.

Benefits are provided for diet therapy or dietary counseling when the services are included in the fee for the overall program.

Exclusions

Specific Criteria Not Covered by Medicaid DSME is not covered if the beneficiary does not have a diagnosis of diabetes. If the program does not meet the requirements for staff qualifications as recognized providers by the American Diabetes Association, or the Diabetes Education Accredited Programs DSME is not covered. Diet therapy or dietary counseling as a separate charge is not covered. Meals provided during an Outpatient Diabetes Self-Care Program are not covered.

Place of Service

Physician’s office, outpatient hospital department, physician diagnostic clinic, local health department, rural health clinic, federally qualified health center.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-24
• Records Management and Documentation Manual

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required