65757
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- The use of DMEK, DSEK, DSAEK and DMAEK, is consideredmedically necessaryfor the treatment of disorders of the corneal endothelium, including but not limited to the following:
- Fuchs’ endothelial dystrophy;
- Aphakic and pseudophakic bullous keratopathy (corneal edema following cataract extraction);
- Failure or rejection of a previous corneal transplant.
1 Active Policy
ANTHEM-CG-SURG-72 — CG-SURG-72 Endothelial Keratoplasty
Related Codes
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