WAIVER FOR SERVICE
The doctors at Bay Street Pediatrics highly recommend hearing and vision screenings for your child each year. If you choose not to have this done at their physical we recommend your child see a specialist for these tests.
I understand that Bay Street Pediatrics will bill my insurance company for the services that may be provided today. If it is determined that these services are not eligible for coverage, I understand that I will be responsible for payment of all services provided.
OAE Hearing Test (92587) $95.00
OAE is an Otoacoustic emissions hearing test. A small probe is placed in the ear. If the cochlea is functioning properly, it should echo in response to the sound. If your child fails the test you might be referred to an audiologist for further testing.
Pediavision (99177) $30.00
Pediavision screens for astigmatism, myopia, hyperopia, anisometrophia, strabismus, amblyopia, anisocoria. Pediavision uses an infrared camera that combines auto refraction and video retinoscopy. The camera is used to take a digital photograph; the information acquired is used to automatically assess a child’s vision in as little as five seconds. If your child fails the test you might be referred to an ophthalmologist for further testing.