92287
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.39
Facility
$4.33
Non-Facility
$4.33
Documentation Required
- No explicit separate documentation requirements section provided in the policy.
- When billed with CPT 92286, documentation must include the interpretation and report (92286 includes 'with interpretation and report; with specular endothelial microscopy and cell count').
- Clinical documentation should support one of the covered indications (e.g., record of planned extended-wear contact lens fitting after intraocular surgery, planned secondary IOL implantation, planned surgical procedure with higher risk to the corneal endothelium, history of prior intraocular surgery and need for cataract surgery).
- For slit-lamp related indications, documentation should include slit-lamp findings demonstrating corneal edema or endothelial dystrophy (e.g., corneal guttata/Fuch's dystrophy).
Key Coverage Criteria
- Members who are about to be fitted with extended wear contact lenses after intraocular surgery.
- Members who are about to undergo a secondary intraocular lens implantation.
- Members who are about to undergo a surgical procedure associated with a higher risk to corneal endothelium.
- Members who have had previous intraocular surgery and require cataract surgery.
- Members who have slit-lamp evidence of corneal edema (unilateral or bilateral).
- Members who have slit-lamp evidence of endothelial dystrophy (corneal guttata, i.e., Fuch's dystrophy).
1 Active Policy
AETNA-CPB-0538 — Endothelial Cell Photography
Related Codes
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