Does 30930 require prior authorization?

No, 30930 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 30930?

Medicare facility rate: $108.89. Non-facility rate: $108.89. Work RVU: 1.28.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.28

Facility

$108.89

Non-Facility

$108.89

If a provider bills CPT codes that imply stenting (e.g., 68815 with tube/stent insertion), documentation must clarify type of stent; note that the policy states silicone stenting in balloon dacryocystoplasty is considered experimental/investigational and silicone stenting is explicitly noted as 'not covered' in the CPT description context
For DCR: documentation that the patient has nasolacrimal duct obstruction and has persistent symptoms despite nasolacrimal duct probing (policy phrase: "Dacryocystorhinostomy ... for persons with nasolacrimal duct obstruction with persistent symptoms despite nasolacrimal duct probing").
For balloon dacryocystoplasty for congenital NLDO: documentation that congenital nasolacrimal duct obstruction "cannot be cured by probing" and that the member is over 1 year of age (policy phrase: "congenital nasolacrimal duct obstruction that can not be cured by probing (members should be over 1 year of age)").

Balloon dacryocystoplasty (balloon dacryoplasty) for the treatment of: a mucocele of the lacrimal sac.
Balloon dacryocystoplasty for the treatment of: chronic dacryocystitis or conjunctivitis due to lacrimal sac obstruction.
Balloon dacryocystoplasty for the treatment of: congenital nasolacrimal duct obstruction that can not be cured by probing (members should be over 1 year of age).
Balloon dacryocystoplasty for the treatment of: epiphora (excessive tearing) due to acquired obstruction within the nasolacrimal sac and duct.
Balloon dacryocystoplasty for the treatment of: lacrimal sac infection that must be relieved before intra-ocular surgery.
Dacryocystorhinostomy (including transcanalicular laser-assisted dacryocystorhinostomy) for persons with nasolacrimal duct obstruction with persistent symptoms despite nasolacrimal duct probing.

AETNA-CPB-0420 — Nasolacrimal Duct Obstruction: Treatments

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