Does V2631 require prior authorization?

No, V2631 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for V2631?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

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).

Meeting vocational or recreational needs;or
Other daily activities;and
Cataract removal surgery in adults is consideredmedically necessaryforanyof the following:
The lens displays signs of cataract formation and the following criteria are met:The cataract is causing symptomatic impairment of visual function not correctable with a tolerable change in glasses or contact lenses;andVision loss interferes with one or more of the following:Reading;orViewing television;orDriving;orMeeting vocational or recreational needs;orOther daily activities;andOther eye disease(s) have been ruled out as the primary cause of decreased visual function including, but not limi [...]
The cataract is causing symptomatic impairment of visual function not correctable with a tolerable change in glasses or contact lenses;and
Vision loss interferes with one or more of the following:Reading;orViewing television;orDriving;orMeeting vocational or recreational needs;orOther daily activities;and

ANTHEM-CG-SURG-40, CG-SURG-40 Cataract Removal Surgery for Adults

ANTHEM-CG-SURG-77, CG-SURG-77 Refractive Surgery

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)

Ask Verity about documentation requirements, denial risks, or coverage in your state.