Does 68761 require prior authorization?

No, 68761 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 68761?

Medicare facility rate: $103.54. Non-facility rate: $143.29. Work RVU: 1.37.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.37

Facility

$103.54

Non-Facility

$143.29

Eye Prostheses Refractive Lenses: 'Standard Documentation Requirements for All Claims Submitted to DME MACs' (exact title listed; specific required documents not provided in this excerpt).
Amniotic membrane billing guidance referenced: 'Billing and Coding: Amniotic Membrane Billing Guidelines for HCPCS Code V2790' (title implies specific billing/documentation rules for V2790, but the detailed requirements are not included here).
No specific clinical records, test results, or required clinical notes are included in this excerpt — the table only references documents that contain documentation requirements.
Documentation of clinical diagnosis of ocular surface disease / dry eye disease (signs, symptoms, and diagnosis).

92499 Unlisted ophthalmological service or procedure
Treatment of moderate to severe dry eye in Sjogren's syndrome
Ophthalmologic evaluation, including one or more of the following tests: Schirmer test (tear test) (83861)
DED/OSD due to increased tear evaporation (for example, meibomian gland dysfunction).
Symptomatic OSD causing eye discomfort (burning, dry eye, foreign body sensation, photophobia, tearing), visual disturbances, or potential damage to the ocular surface.
Procedural and advanced therapies for OSD/DED when first-line treatments have proven unsuccessful.

HUMANA-OCULAR-SURFACE-DISEASE-DIAGNOSIS-AND-TREATMENTS-MA — Ocular Surface Disease Diagnosis and Treatments - Medicare Advantage

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