Does 66170 require prior authorization?

No, 66170 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 66170?

Medicare facility rate: $938.23. Non-facility rate: $938.23. Work RVU: 13.59.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

13.59

Facility

$938.23

Non-Facility

$938.23

Billing, coding, and other guidelines for Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza®) must follow and complement Local Coverage Determination L38792.
Document the qualifying ophthalmic surgery and the post-operative diagnosis of ocular inflammation.
Document the qualifying ophthalmic surgery and the post-operative diagnosis of ocular pain.
Document absence of active corneal, conjunctival, or canalicular infections (screening/exam findings) prior to insert placement.

Dextenza is covered for treatment of ocular inflammation following ophthalmic surgery.
Dextenza is covered for treatment of ocular pain following ophthalmic surgery.
Primary congenital glaucoma (PCG) — viscocanalostomy/combined viscocanalostomy and trabeculotomy were studied in pediatric PCG (Qian 2017; Cochrane review includes trials comparing viscocanalostomy).
Use as a MIGS (minimally invasive glaucoma surgery) option for earlier-stage glaucoma where bleb-related complications are a concern — e.g., statement: "Canaloplasty will likely be used most often in earlier stages of glaucoma...may also be indicated in patients who may not need IOP-lowering to the degree that is achievable with trabeculectomy."
Procedures / devices discussed (clinical contexts in which they were studied): viscocanalostomy, phacoviscocanalostomy, canaloplasty (including iTrack/Glaucolight microcatheter approaches), canaloplasty with Stegmann Canal Expander, ab interno canaloplasty (ABiC), OMNI Surgical System (360° canaloplasty + 180° trabeculotomy), Visco360, iStent, Trabectome, GATT combined with ABiC.
Combined gonioscopy-assisted transluminal trabeculotomy (GATT) with Ab interno canaloplasty (ABiC) in conjunction with phacoemulsification for the treatment of patients with POAG

AETNA-CPB-0435 — Viscocanalostomy and Canaloplasty

A58392 — Billing and Coding: Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza)

L38792 — Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza)

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