66999
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
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 [...]
- Aqueous shunts/aqueous drainage devices (CPT/HCPCS Codes 66179, 66183) are considered medically necessary for refractory glaucoma when there is failure, intolerance or contraindication to conventional medical (i.e., topical or oral medication) and surgical (i.e., laser therapy, trabeculectomy) treatment. Devices listed: Ahmed glaucoma valve; Baerveldt glaucoma implant; ExPRESS mini glaucoma shunt; Krupin eye valve; Molteno implant.
- Insertion of a single XEN 45 Gel Stent (CPT Codes 0449T, 66183) is considered medically necessary for the management of refractory glaucoma, including any of the following: primary open angle glaucoma; failure of previous surgical treatment; pseudoexfoliative or pigmentary glaucoma with open angles that is unresponsive to maximum tolerated medical therapy.
- Insertion of iStent Infinite (CPT 0671T) in an individual age 18 years or older with open-angle glaucoma is considered medically necessary when there is failure, intolerance or contraindication to conventional medical and surgical treatment for reduction of intraocular pressure.
- Canaloplasty (CPT Codes 66174, 66175), whether performed ab externo or ab interno, is considered medically necessary in an individual age 18 years or older for the treatment of open-angle glaucoma when there is failure, intolerance or contraindication to conventional medical management (i.e., topical or oral medication).
11 Active Policies
CIGNA-0141 — Corneal Remodeling for Refractive Errors - (0141)
CIGNA-0035 — Glaucoma Surgical Procedures - (0035)
ANTHEM-CG-SURG-105 — CG-SURG-105 Corneal Collagen Cross-Linking
ANTHEM-CG-SURG-77 — CG-SURG-77 Refractive Surgery
ANTHEM-CG-SURG-124 — CG-SURG-124 Viscocanalostomy
Related Codes
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