Does 67221 require prior authorization?

No, 67221 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 67221?

Medicare facility rate: $168.34. Non-facility rate: $284.24. Work RVU: 3.36.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.36

Facility

$168.34

Non-Facility

$284.24

No explicit Medicare/coverage-specific documentation requirements are stated in this document.
For IMT: Documentation of evidence of a visually significant cataract (grade 2 or higher).
"Visual acuity poorer than 20/160, but not worse than 20/800 in both eyes;"
"Willingness to participate in a post-operative visual rehabilitation program."

Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Aflibercept (Eylea) injection (CPB 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Indications).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Bevacizumab (Avastin) injection (CPB 0685 - Bevacizumab for Non-Ocular Indications).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Pegaptanib sodium (Macugen) injection (CPB 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Indications).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Photodynamic therapy (PDT) with light-activated verteporfin (CPB 0594 - Visudyne (Verteporfin) Photodynamic Therapy).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Ranibizumab (Lucentis) injection (CPB 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Indications).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Brolucizumab (Beovu) injection (CPB 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Indications).

AETNA-CPB-0594 — Verteporfin (Visudyne) Photodynamic Therapy

AETNA-CPB-0765 — Age-Related Macular Degeneration

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