Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57483 (Billing and Coding: Visual Fields) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57483: Billing and Coding: Visual Fields (Billing and Coding, effective 2025-10-01)
- Covered ICD-10-CM codes
- 1824
- 2 groups
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 3
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| A18.51 | — |
| A18.53 | — |
| A18.54 | — |
| A18.59 | — |
| A52.15 | — |
| A52.2 | — |
| A52.71 | — |
| B58.01 | — |
| C69.01 | — |
| C69.02 | — |
| C69.11 | — |
| C69.12 | — |
| C69.21 | — |
| C69.22 | — |
| C69.31 | — |
| C69.32 | — |
| C69.41 | — |
| C69.42 | — |
| C69.51 | — |
| C69.52 | — |
| C69.61 | — |
| C69.62 | — |
| C69.81 | — |
| C69.82 | — |
Procedure codes: 92081, 92082, 92083.
Coverage indications, limitations and medical necessity
Visual fields are examined using static or kinetic perimetry. The procedure is performed separately for each eye, and measures the combined function of the retina, the optic nerve, and the intracranial visual pathway. It is used clinically to detect or monitor field loss due to disease at any of these locations. Visual fields may be determined by several methods including a tangent screen, Goldmann perimeter, and computerized automated perimeters.
Visual field examinations will be considered medically necessary under the following conditions:
• Disorder of the eyelids, potentially affecting the visual field.
A documented diagnosis of glaucoma.
Stabilization or progression of glaucoma can be monitored by a visual field examination, or by such services as scanning computerized ophthalmic diagnostic imaging. This evaluation must be performed at regular intervals to determine that the prescribed management is adequately controlling progression of disease to the degree possible. The frequency of such examinations is dependent on clinical judgment as well as the variability of intraocular pressure measurements (e.g., progressive increases despite treatment indicate a worsening condition), the appearance of new hemorrhages, and progressive cupping of the optic nerve.
A diagnosis of glaucoma is suspected with supporting evidence documented.
A suspected diagnosis of glaucoma is evidenced by an increase in intraocular pressure over time, intraocular pressures of 22 mm Hg or more, asymmetric intraocular measurements of greater than 2 mm Hg between the 2 eyes, or optic nerves suspicious for glaucoma, which may be manifested as asymmetrical cupping, a change in the cup-to-disc ratio over time, disc hemorrhage, or an absent, thinned, or notched neural rim. Additional possible indicators of glaucoma suspicion are fallout of the retinal nerve fiber layer, optic atrophy (pallor of the optic nerve), corneal endothelial pigment deposits (Krukenburg's Spindle), dense pigmentation of the trabecular meshwork as evidenced by gonioscopy, pseudoexfoliation of the lens, or dense exfoliative deposits on the trabecular meshwork as evidenced by gonioscopy.
A documented disorder of the optic nerve, the neurologic visual pathway, or retina.
Patients with a previously diagnosed retinal detachment do not need a pretreatment visual field examination. Additionally, patients with an established diagnosed cataract do not need a follow-up visual field unless other presenting symptomatology is documented. In patients who are about to undergo cataract extraction, who do not have glaucoma and are not glaucoma suspects, a visual field would not be indicated.
A recent intracranial hemorrhage, an intracranial mass, or a recent measurement of increased intracranial pressure with or without visual symptomatology.
A recently documented occlusion and/or stenosis of cerebral and precerebral arteries, a recently diagnosed transient cerebral ischemia, or giant cell arteritis.
A history of a cerebral aneurysm, pituitary tumor, occipital tumor, or other condition potentially affecting the visual fields.
A visual field defect demonstrated by gross visual field testing (e.g., confrontation testing).
An initial workup for buphthalmos, congenital anomalies of the posterior segment, or congenital ptosis.
A disorder of the orbit, potentially affecting the visual field (e.g., orbital tumor, thyroid disease, etc.).
A significant eye injury.
Unexplained visual loss which may be described as "trouble seeing or vision going in and out."
A pale or swollen optic nerve documented by a recent examination.
New functional limitations which may be due to visual field loss (e.g., reports by family that the patient is running into things).
Medication treatment (e.g., hydroxychloroquine) which has a high risk of potentially affecting the visual system.
• Initial evaluation for macular degeneration related to central vision loss or has experienced such loss resulting in vision measured at or below 20/70.
Limitations
Gross visual field testing (e.g., confrontation testing) is a part of general ophthalmological services and should not be reported separately.
Frequency of examinations for a diagnosis of macular degeneration or an experienced central vision loss (or to evaluate the results of a surgical intervention or for the possible need for surgical intervention) is dictated by stage of disease or degree of risk factors, just as with glaucoma evaluation.
Claims submitted for visual field examinations performed at unusually frequent intervals may be reviewed to verify that the services were medically reasonable and necessary.
Summary of evidence (opening)
N/A
The contractor cites 2 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2025-05-29
- Last reviewed by the contractor
- 2025-04-28
- MCD version
- 42
- Derived from
- L31348
The contractor lists one National Coverage Determination as related: NCD 80.9 Computer Enhanced Perimetry. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Wisconsin Physicians Service Insurance Corporation hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34615 cover?
Visual fields are examined using static or kinetic perimetry. The procedure is performed separately for each eye, and measures the combined function of the retina, the optic nerve, and the intracranial visual pathway. It is used clinically to detect or monitor field loss due to disease at any of these locations. Visual fields may be determined by several methods including a tangent screen, Goldmann perimeter, and… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34615 apply to?
Wisconsin Physicians Service Insurance Corporation applies it to Medicare claims in AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34615?
The companion billing and coding article A57483 lists 1,824 ICD-10-CM codes in 2 groups that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34615?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.