Does 0474T require prior authorization?

No, 0474T does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 0474T?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Maintain complete medical records that support medical necessity; records must be available to the contractor upon request.
Documentation must include previous treatments and response to treatment.
Every page of the record must be legible and include appropriate patient identification information and dates of service.
Records must include the legible signature of the physician or non-physician practitioner responsible for the care.

Use CPT 66991 for noncomplex cataract removal with insertion of intraocular lens (IOL) implant and concomitant intraocular aqueous drainage device when LCD medically reasonable and necessary criteria are met.
Use CPT 66989 for complex cataract removal with IOL implant and concomitant intraocular aqueous drainage device when LCD medically reasonable and necessary criteria are met.
Report goniotomy with CPT 65820 when the trabecular meshwork is incised and/or excised for at least three clock hours to create an opening into Schlemm canal from the anterior chamber; 65820 is reported per eye.
Report unlisted anterior segment code CPT 66999 for goniopuncture or microgoniotomy procedures (no specific CPT exists) and identify the procedure in the narrative.
CPT 66991 may be reported for noncomplex cataract removal with intraocular lens (IOL) implant performed with concomitant intraocular aqueous drainage device insertion (e.g., iStent) when the medically reasonable and necessary criteria in the related LCD are met.
CPT 66989 may be reported for complex cataract removal with IOL implant performed with concomitant intraocular aqueous drainage device insertion when the medically reasonable and necessary criteria in the related LCD are met.

A59807 — Billing and Coding: Micro-Invasive Glaucoma Surgery

J05

L39907 — Micro-Invasive Glaucoma Surgery (MIGS)

J05

L37244 — Micro-Invasive Glaucoma Surgery (MIGS)

J06

A56588 — Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)

J06

L38926

Ask Verity about documentation requirements, denial risks, or coverage in your state.