Does 66986 require prior authorization?

No, 66986 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 66986?

Medicare facility rate: $764.21. Non-facility rate: $764.21. Work RVU: 11.95.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

11.95

Facility

$764.21

Non-Facility

$764.21

Clinical documentation of refractive testing demonstrating anisometropia ≥2 diopters and documentation that vision cannot be corrected with glasses or contact lenses.
Operative/clinical documentation showing anatomical change, inflammatory response, or mechanical failure demonstrating the previously implanted monofocal IOL is ineffective or nonfunctional.
Documentation that the patient meets all required clinical criteria for monocular IMT implantation (as specified elsewhere in the policy).
Proof of patient age (≥65).

Replacement of the natural crystalline lens when the natural lens becomes cataractous.
Lens replacement following trauma to the eye that has damaged the lens.
Treatment of congenital cataract.
Treatment of congenital aphakia.
Lens subluxation or displacement requiring lens replacement.
Anisometropia of ≥2 diopters that is not correctable with glasses or contact lenses.

BCBSIL-SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

BCBSMT-SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

BCBSNM-SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

BCBSOK-SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

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