Medicare Coverage of Visual Field Testing

What It Is

Eye examination to detect and diagnose illness or injury

What's Covered

Medicare Part B and all Medicare Part C plans cover a visual field test if performed by an ophthalmologist (an M.D. specializing in eye care) to detect or diagnose eye disease (such as glaucoma or retinitis) or injury. Medicare Part B does not cover a visual field test as part of a regular eye examination to determine the need for eyeglasses or other corrective lenses. For people diagnosed with diabetes, Medicare Part B and Medicare Part C plans cover yearly eye examinations, which can include a visual field test, for diabetic retinopathy and glaucoma.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans must cover everything that's included in original Medicare Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. To find out whether your Medicare Part C plan provides extra coverage for a visual field test, contact the plan directly.

What Medicare Pays

Medicare Part B pays 80 percent of the Medicare-approved amount for a covered visual field test. Co-payments under a Medicare Part C plan may be different than those for Medicare Part B.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

3 Comments So Far. Add Your Wisdom.

8 months ago

Why do I have to pay a co-pay for a Visual Field Test which is done by a technician? This new doctor sees me, orders a visual field test and then has me come back a third time to dilate my eyes. That is 3 co-pays and three visits that they are billing for. My last doctor use to get the visual field test, then dilate my eyes and check the pressure.

10 months ago

Where do I locate the Policy for HCPCS 92081,92082,92083 which includes indications and limitations of coverage and or medical necessity (ICD9CM codes and discriptions

about 1 year ago

Will Medicare pay for a vision field test to determine eye damage due to the drug plaquenil? Does the physician need to be an Opthomologists or can I see an Optometrist & if new glasses are necessary, will Medicare pay anything on them?


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