65710
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
14.09
Facility
$982.99
Non-Facility
$982.99
Documentation Required
- For corneal relaxing incisions (CPT 65772): documentation of surgically-induced astigmatism ≥3.00 D, documentation that procedure is post-cataract or post-corneal transplant surgery, and documentation that the individual is intolerant of glasses or contact lenses.
- For intrastromal corneal ring segments (CPT 65785) per HDE: documentation that the individual meets ALL HDE criteria: progressive deterioration in vision such that adequate functional vision on a daily basis with contact lenses or spectacles can no longer be achieved; age ≥21 years; clear central corneas; corneal thickness ≥450 microns at the proposed incision site (measurements recorded); and documentation that corneal transplantation is the only remaining option to improve functional vision.
- Evidence that the intrastromal corneal ring segment implantation is performed in accordance with the FDA HDE specifications (device and indication alignment with HDE).
Key Coverage Criteria
- Corneal relaxing incision (CPT 65772) for correction of surgically-induced astigmatism of 3.00 diopters (D) or greater when performed post-cataract or post-corneal transplant surgery in an individual who is intolerant of glasses or contact lenses (considered medically necessary).
- Insertion/implantation of intrastromal corneal ring segments (CPT 65785) when provided in accordance with the FDA Humanitarian Device Exemption (HDE) specifications (e.g., INTACS® prescription inserts) for treatment of myopia and astigmatism in individuals with keratoconus who meet ALL of the following criteria: progressive deterioration in vision such that adequate functional vision on a daily basis with contact lenses or spectacles can no longer be achieved; age 21 years or older; clear centra [...]
1 Active Policy
CIGNA-0141 — Corneal Remodeling for Refractive Errors - (0141)
Related Codes
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