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Ophthalmic Diagnostic Imaging Policy Revision: Effective September 1, 2026

Date: 07/07/26

Thank you for your continued partnership with Sunflower Health Plan. As you know, we continually review and update our payment and utilization policies to ensure that they comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of the revision to existing policies Sunflower will be implementing effectively with dates of service starting September 1, 2026. Posted policy on site contains a revision log explaining the updates that occurred in the annual review.

Lines of Business: Marketplace, Commercial

Policy Number: CP.VP.14

Policy Name: Scanning Computerized Ophthalmic Diagnostic Imaging

Policy Description: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) is a non-invasive, non-contact imaging technique that produces high resolution, cross-sectional tomographic images of ocular structures and is used for the evaluation of anterior segment and posterior segment diseases. This policy describes the medical necessity indications for SCODI.

It is the policy of health plans affiliated with Centene Corporation® (Centene) and Envolve Vision, Inc.® (Envolve) that SCODI is medically necessary for the following indications:

  • Anterior SCODI
  • Posterior Optic nerve SCODI
  • Posterior retinal SCODI, and posterior retinal SCODI including OCT angiography

It is the policy of health plans affiliated with Centene and Envolve that SCODI is not medically necessary for the following indications: 

  • Advanced glaucomatous damage
  • Screening for glaucoma

Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call us at the numbers below:

 

Ambetter from Sunflower Health Plan is underwritten by Celtic Insurance Company, which is a Qualified Health Plan issuer in the Kansas Health Insurance Marketplace. ©2026 Celtic Insurance Company. All rights reserved.