Medicare Coverage of Visual Field Testing
What It Is
Eye examination to detect and diagnose illness or injury
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.
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