Orthoptics and pleoptics are common forms of vision therapy. Orthoptics are exercises designed to improve the function of the eye muscles. These exercises are considered particularly useful in the treatment of strabismus (cross-eyes). Pleoptics are exercises designed to improve impaired vision when there is no evidence of organic eye diseases.

Generally, positive results can be achieved with 3 to 12 consecutive months of treatment, at an average rate of two exercise sessions per week. Whether performed by a physician, optometrist, or licensed physical therapist (when prescribed by a physician or optometrist), payment may be allowed for a maximum of two exercise sessions per week for one treatment period of six consecutive months. If the vision therapy exceeds the 6-month limitation, documentation will be required to substantiate the medical necessity for further treatments.

The most common diagnoses for which payment may be allowed are amblyopia, strabismus, accommodative dysfunction, and general binocular dysfunction.

Vision therapy for the treatment of learning disabilities, poor school test scores, and behavioral problems is considered not of proven value.

Claims involving any other diagnosis should be referred for a medical review.

Orthoptics and pleoptics are eligible for the nonsurgical treatment of amblyopia and strabismus for children ages from birth to age 12. No restrictions on the number of sessions or treatments apply.

PRN References

06/1997, Vision therapy