Does C1840 require prior authorization?

No, C1840 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C1840` — Lens, intraocular (telescopic)

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Clinical documentation of refractive testing demonstrating anisometropia ≥2 diopters and documentation that vision cannot be corrected with glasses or contact lenses.
Operative/clinical documentation showing anatomical change, inflammatory response, or mechanical failure demonstrating the previously implanted monofocal IOL is ineffective or nonfunctional.
Documentation that the patient meets all required clinical criteria for monocular IMT implantation (as specified elsewhere in the policy).
Proof of patient age (≥65).

Agree to participate in postoperative visual training with a low vision specialist;and
An intraocular telescope (for example, the Implantable Miniature Telescope) is consideredmedically necessaryfor monocular implantation to improve vision in individuals 65 years of age or older when all of the following criteria are met:
Achieve at least a 5-letter improvement on the Early Treatment Diabetic Retinopathy Study chart with an external telescope in the eye scheduled for surgery;and
Agree to undergo pre-surgery training and assessment (typically 2 to 4 sessions) with low vision specialists (optometrist or occupational therapist) in the use of an external telescope sufficient for assessment and for the individual to make an informed decision;and
Have adequate peripheral vision in the eye not scheduled for surgery;and
Have retinal findings of geographic atrophy or disciform scar with foveal involvement, as determined by fluorescein angiography;and

ANTHEM-CG-SURG-96 — CG-SURG-96 Intraocular Telescope

BCBSIL-SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

BCBSMT-SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

BCBSNM-SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

BCBSOK-SUR713.025 — Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT)

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