Does 65435 require prior authorization?

No, 65435 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 65435?

Medicare facility rate: $60.46. Non-facility rate: $83.50. Work RVU: 0.90.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.90

Facility

$60.46

Non-Facility

$83.50

Members and providers must consult and document the member's benefit plan/summary plan description/contract to determine applicable coverage, exclusions, caps, or limitations.
Clinical documentation demonstrating failure or insufficiency of prior medical/conservative therapies.
Record of specific prior treatments tried (e.g., lubricants, patching, bandage contact lenses, anterior stromal punctures, rigid contact lens use) and treatment durations/outcomes.
Clinical documentation of recurrent corneal erosions diagnosis.

Superficial corneal dystrophy (including granular, lattice, and Reis-Bückler's dystrophy).
Epithelial membrane dystrophy.
Irregular corneal surfaces due to Salzmann's nodular degeneration or keratoconus nodule.
Corneal scars and opacities, including post-traumatic, post-infectious, postsurgical, and secondary to pathology.
Recurrent corneal erosions when more conservative measures (e.g., lubricants, hypertonic saline, patching, bandage contact lenses, gentle debridement of severely aberrant epithelium) have failed.
Phototherapeutic keratectomy (PTK) is used for correction of particular corneal diseases.

BCBSIL-SUR713.023 — Phototherapeutic Keratectomy

BCBSMT-SUR713.023 — Phototherapeutic Keratectomy

BCBSNM-SUR713.023 — Phototherapeutic Keratectomy

BCBSOK-SUR713.023 — Phototherapeutic Keratectomy

SUR713.023 — Phototherapeutic Keratectomy

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