92316
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.66
Facility
$26.39
Non-Facility
$97.86
Documentation Required
- Providers must maintain a copy of the material invoice and a detailed description of the item(s) for all codes that are manually priced per the fee schedule.
- Adhere to payer-specific administrative agreements and applicable federal/state (CMS or State Medicaid) guidelines; consult plan specifics and the applicable State Medicaid manual for payable services.
- Providers must reference the most up-to-date CPT coding guidance and current professional coding sources prior to claims submission.
- Documentation that the patient has received refractive hardware must be maintained.
Key Coverage Criteria
- Bandage contact lenses for noninfectious keratitis or corneal ulceration
- Bandage contact lenses for recurrent corneal erosion
- Bandage contact lenses for corneal abrasion, injury, burn, or other trauma
- Bandage contact lenses for corneal perforation
- Bandage contact lenses following corneal transplantation
- Bandage contact lenses for dry eye refractory to more conservative treatments, including frequent artificial tears
2 Active Policies
AMBETTER-CP.VP.06 — Medically Necessary Optical Hardware
AMBETTER-CP.VP.13-Attachment-A-Refractive-Hardware — Preventive (Routine) Eye Examination Attachment A: Refractive Hardware
Related Codes
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