Adult Strabismus Surgery
This policy statement addresses the treatment of adult strabismus, a condition characterized by abnormal binocular alignment of the eyes, and highlights the benefits of strabismus surgery for adults. Surgery can alleviate symptoms like diplopia (double vision), visual confusion, and abnormal head posture, while also restoring binocular vision, improving visual fields, and enhancing psychosocial function. Indications for surgery include diplopia, visual confusion, difficulty with prism glasses or patching, and the need for enhanced vocational or social functioning. The statement stresses that successful surgery can greatly improve quality of life by addressing visual and psychosocial disabilities caused by strabismus, and recommends that adults with this condition consult with their ophthalmologist for further evaluation.
Policy Statement | May 2017
Amblyopia is a Medical Condition
This joint policy statement by the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Ophthalmology asserts that amblyopia is a medical condition requiring treatment. It highlights that amblyopia, a preventable and treatable form of vision loss, is caused by developmental abnormalities in the brain's vision centers and emphasizes the importance of early diagnosis and intervention to prevent permanent visual impairment. The statement also notes that preschool vision screening can identify risk factors, and optical correction may be part of the treatment plan.
Joint Statement | April 2017
“Computer Vision Syndrome” and Children
This policy statement clarifies that there is no scientific evidence linking screen time to vision problems in children, as their eyes are naturally flexible and can easily adapt to visual environments. While limiting screen time is important for other health reasons, such as preventing obesity and attention-related disorders, there is no indication that it affects the developing visual system. The American Academy of Pediatrics recommends screen time limitations for young children to support their overall development.
Policy Statement
Determination of Refractive Error by Refraction in Infants and Children
This policy statement outlines the importance of refraction in diagnosing and treating childhood eye diseases and vision abnormalities. Refraction helps determine refractive errors, which, if untreated, can lead to conditions like amblyopia and strabismus, potentially resulting in permanent vision loss. The policy clarifies that refraction is not included in ophthalmology exam codes or Evaluation/Management (E/M) procedures and must be reported separately using CPT® code 92015. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) recognizes refractions in children as medically necessary and eligible for reimbursement as a separate service.
Policy Statement | March 2017
Medical Need for Glasses
This policy statement emphasizes the medical necessity of glasses for children to treat and prevent vision loss from conditions such as amblyopia, strabismus, aphakia, and significant refractive errors. It highlights the importance of timely prescription and replacement to support normal visual, social, and intellectual development. The statement underscores that delayed access to appropriate glasses can lead to permanent vision impairment, making them essential for a child’s overall well-being.
Policy Statement | May 2017
Medically Necessary Eye Examinations for Children Who Have Failed Vision Screening
This policy statement asserts that comprehensive eye examinations are medically necessary for children who fail vision screenings, even if no ocular pathology is found. Early detection of eye diseases and vision disorders, such as amblyopia and strabismus, is crucial for preventing irreversible vision loss. The statement emphasizes that such exams are essential for ensuring proper eye health and are not considered routine care.
Policy Statement | March 2017
Need for Vitrectomy When Performing Pediatric Cataract Surgery
This policy statement outlines the necessity of performing a vitrectomy during pediatric cataract surgery to ensure the best visual outcome for children, especially those under 9 years of age, who are at risk of developing secondary cataracts. The vitrectomy procedure involves the excision of the posterior lens capsule, anterior hyaloid membrane, and anterior vitreous, and is typically planned prior to cataract surgery to prevent permanent vision loss. The statement emphasizes that vitrectomy is a medically necessary procedure and should be reimbursed accordingly.
Policy Statement | March 2017
Optical Treatment of Children Following Cataract Surgery (Aphakia and Pseudophakia)
This policy statement emphasizes the necessity of urgent optical treatment following cataract surgery in children to prevent permanent visual impairment. It highlights the importance of individualized optical correction, including aphakic contact lenses, glasses, or intraocular lenses, and stresses the need for frequent adjustments as children grow. The statement advocates for insurance coverage of these medically necessary optical treatments to ensure proper visual habilitation and prevent amblyopia.
Policy Statement | March 2017
Orthoptists as Physician Extenders
This policy statement recognizes orthoptists as valuable physician extenders in the field of pediatric ophthalmology, particularly for treating strabismus and binocular vision disorders. Orthoptists are qualified to independently evaluate and treat patients with eye movement and binocular vision issues. They are considered similar to nurse practitioners and physician assistants in terms of their role in providing care under the supervision of an ophthalmologist. The policy highlights the extensive education and certification required for orthoptists, and it defines the supervision levels under Medicare for procedures like sensorimotor exams and orthoptic training.
Policy Statement | March 2017
Pathology Exclusions for Muscle Resection Specimens Policy Statement
This policy statement advocates for the exclusion of extraocular muscle resection specimens from mandatory pathological examination requirements, as they are typically histologically normal in cases of comitant strabismus. It emphasizes that such examinations are usually unnecessary and impose additional costs. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) supports allowing surgeons to request pathology only when deemed clinically necessary.
Policy Statement | May 2017
Pediatric Oculoplastic Surgery
This policy statement asserts the medical necessity of pediatric oculoplastic surgeries and rejects unnecessary insurance requirements, such as imaging or external photos, which may not be feasible for children. It clarifies reimbursement guidelines for conditions like periorbital lesions, eyelid abnormalities, and nasolacrimal duct obstruction, emphasizing the need for appropriate coding and separate billing for distinct procedures. The statement also calls for ethical reimbursement practices, particularly for surgeries performed under anesthesia, and stresses that unrelated postoperative care should be fully covered under appropriate billing modifiers.
Policy Statement | January 2025
Professional Titles and the Use of the Term “Provider”
Words matter. In medicine, they shape how patients understand their care, how physicians view their profession, and how society values the years of education and responsibility required to become a physician.
The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) believes physicians should be identified by their profession—not by generic administrative terminology. Whenever possible, pediatric ophthalmologists should be referred to as physicians, ophthalmologists, pediatric ophthalmologists, or surgeons, rather than as "providers."
The term provider arose from the language of reimbursement and health care administration. It serves a purpose in contracts, insurance regulations, and billing systems, where it encompasses many individuals and organizations that deliver health-related services. That administrative usefulness, however, should not dictate how physicians are described to patients or within our profession.
Following four years of college, pediatric ophthalmologists complete four years of medical school, one year of internship, three years of ophthalmology residency, and at least one year of fellowship training devoted to the medical and surgical care of children with eye disease. The word provider does not convey that expertise, nor does it reflect the ethical and professional obligations assumed by physicians. It also fails to recognize the unique training and contributions of other members of the health care team, each of whom deserves to be identified accurately.
Patients increasingly receive care from multidisciplinary teams. AAPOS strongly supports this collaborative model. Collaboration, however, is strengthened—not weakened—when every professional is identified by his or her actual role. Referring to an orthoptist as an orthoptist, an optometrist as an optometrist, a nurse practitioner as a nurse practitioner, and a physician as a physician, promotes transparency and helps patients make informed decisions about their care.
There is another reason this conversation matters.
Pediatric ophthalmology is experiencing a growing workforce shortage. Recruiting talented medical students and residents into a demanding surgical subspecialty requires more than competitive compensation. It requires preserving the identity and meaning of the profession itself. Language that reduces physicians to interchangeable participants in a health care delivery system risks diminishing the value of the extensive education, judgment, and accountability that defines medical practice.
AAPOS therefore encourages hospitals, academic medical centers, insurers, electronic medical record vendors, and governmental agencies to use profession-specific titles whenever feasible. Generic terminology may be appropriate in legal, regulatory, or reimbursement contexts, but it should not become the default language of clinical medicine.
This recommendation is not intended to elevate one profession above another. Rather, it affirms that every member of the health care team deserves to be identified accurately and respectfully. Precision in language promotes transparency, professionalism, and trust—qualities that remain central to the physician-patient relationship.
Policy Statement | July 2026
Reimbursements for Children with Negative Findings in Pediatric Eye Exams
This policy statement advocates for appropriate reimbursement for pediatric eye examinations that result in negative findings. It highlights the complexity and necessity of these evaluations, which often require extensive time, testing, and expertise to rule out serious conditions. The statement calls for recognition of the medical necessity of these exams, ensuring that reimbursement reflects the comprehensive care provided, regardless of whether a definitive diagnosis is made.
Policy Statement | April 7, 2024
Reimbursements for Exams Under Anesthesia
This policy statement advocates for appropriate reimbursement of exams under anesthesia (EUAs) performed alongside surgical procedures when sedation is necessary. It emphasizes the medical necessity of EUAs for certain patients and the importance of unbundling necessary diagnostic tests. The statement also calls for consistent reimbursement across all medical settings, coverage for required postoperative care, and full-value payment for multiple procedures performed on the same day.
Policy Statement | February 20, 2024
Sensorimotor Examination
This policy statement affirms the medical necessity and separate reimbursement of sensorimotor examinations (CPT 92060) for evaluating ocular misalignment and binocular function abnormalities. It emphasizes that these exams require additional time, expertise, and measurements beyond standard eye exams or evaluation/management (E/M) visits. The statement outlines documentation requirements, scenarios requiring a physician's order, and the need for formal interpretation. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) asserts that sensorimotor exams should be recognized as distinct, reimbursable services by all insurers.
Policy Statement | July 2021
Use and Disclosure of Clinical Media on the AAPOS Website
The policy statement outlines procedures for the use and disclosure of clinical media on the AAPOS “Learn More About Eyes” webpages. It addresses ownership and consent requirements for both historical and new images. Historical images can be claimed by members with appropriate institutional consent, while new submissions must include an AAPOS-branded consent form. Credit will be given to submitting members, and all consent documentation will be maintained in the AAPOS SharePoint drive. The policy also establishes that only images with documented consent can be approved for use by external publications.
Policy Statement | March 2025
Vigabatrin: The Problem of Monitoring for Peripheral Vision Loss in Children
This policy statement addresses the challenges of monitoring peripheral vision loss in children treated with Vigabatrin, an anti-epileptic drug known to cause retinal toxicity. It highlights the limitations of traditional visual field testing in young, nonverbal patients and suggests alternative monitoring methods, such as serial fundus examinations. The statement emphasizes the need for collaboration between ophthalmologists, neurologists, and families to balance seizure control with potential vision risks and calls for further research to improve early detection of Vigabatrin-induced visual changes.
Policy Statement | July 2017
Vision Screening for Infants and Children
The policy statement emphasizes the importance of early vision screening for infants and children to detect and treat conditions like amblyopia, strabismus, and refractive errors. The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend routine screenings by trained professionals in primary care, schools, and community programs. Early detection improves treatment outcomes and helps prevent irreversible vision loss. Additionally, the policy highlights the need for parental communication and follow-up care to ensure timely interventions.
Joint Statement | September 2022