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Policy Num:      09.003.012

Office-based vergence/accommodative therapy may be considered medically necessary for individuals with symptomatic convergence insufficiency if, following a minimum of 12 weeks of home-based therapy (eg, push-up exercises using an accommodative target, push-up exercises with additional base-out prisms, jump-to-near convergence exercises, stereogram convergence exercises, recession from a target, and maintaining convergence for 30 to 40 seconds), symptoms have failed to improve.

Orthoptic eye exercises are considered investigational for the treatment of learning disabilities.

Orthoptic eye exercises are investigational for all other conditions, including but not limited to the following:

Slow reading

Visual disorders other than convergence insufficiency.

787-277-6653 787-474-6326