65436
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
4.70
Facility
$317.98
Non-Facility
$392.13
Documentation Required
- 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.
Key Coverage Criteria
- 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.
5 Active Policies
BCBSIL-SUR713.023 — Phototherapeutic Keratectomy
BCBSMT-SUR713.023 — Phototherapeutic Keratectomy
BCBSNM-SUR713.023 — Phototherapeutic Keratectomy
BCBSOK-SUR713.023 — Phototherapeutic Keratectomy
SUR713.023 — Phototherapeutic Keratectomy
Related Codes
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