Z87.720 — Personal history of (corrected) congenital malformations of eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Repair of a functional defect caused by trauma, tumor, or surgery;or
- Periorbital sequelae of thyroid disease;or
- Nerve palsy.
- Occlusion Amblyopia (also known as deprivation amblyopia)
- Upper eyelid blepharoplasty or blepharoptosis repair is consideredmedically necessaryto treat occlusion amblyopia when BOTH of the following criteria are met:
- Individual is less than or equal to 9 years of age*;and
1 Active Policy
ANTHEM-CG-SURG-03 — CG-SURG-03 Blepharoplasty, Blepharoptosis Repair, and Brow Lift
Related Codes
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