Does 67042 require prior authorization?

No, 67042 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 67042?

Medicare facility rate: $954.60. Non-facility rate: $954.60. Work RVU: 15.92.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

15.92

Facility

$954.60

Non-Facility

$954.60

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.

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

L38792 — Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza)

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