Does V2788 require prior authorization?

No, V2788 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for V2788?

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

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`V2788`, Presbyopia correcting function of intraocular lens

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Claims must be submitted with the most appropriate diagnosis and procedure codes as of the effective date; claims submitted for services not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.
Coverage determinations require consideration of the terms of the applicable benefit plan document, applicable laws/regulations, collateral source materials including Coverage Policies, and the specific facts of the situation; each coverage request should be reviewed on its own merits (instructional requirement for documentation review).

For anisometropia-related IOL coverage: clinical documentation demonstrating anisometropia of 2 diopters or greater and documentation that vision is uncorrectable with the use of glasses or contact lenses (i.e., refraction results and records of trial/use and intolerance or failure of corrective lenses).

For replacement of previously implanted IOL: documentation demonstrating anatomical change, inflammatory response, or mechanical failure that renders the previously implanted IOL ineffective or nonfunctional (e.g., exam findings, operative/surgical reports, imaging, complication reports, infection/inflammatory diagnosis codes such as T85.79XA-T85.79XS or mechanical complication codes T85.21XA-T85.21XS, T85.22XA-T85.22XS, T85.29XA-T85.29XS).

For cataract-related indications: documentation of cataract diagnosis consistent with covered ICD-10-CM codes (examples and ranges listed in the policy), preoperative evaluation, and indication for cataract extraction with IOL implantation.

General required documentation (inferred): medical records including clinical notes, diagnostic test results (e.g., refraction, visual acuity), prior treatment history and response (e.g., trials of glasses/contact lenses), surgical reports, and diagnosis codes supporting medical necessity.

Key Coverage Criteria

Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: following cataract extraction.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: trauma to the eye which has damaged the lens.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: congenital cataract.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: congenital aphakia.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: lens subluxation/displacement.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: anisometropia of 2 diopters or greater, and uncorrectable vision with the use of glasses or contact lenses.

7 Active Policies

ANTHEM-CG-SURG-77, Refractive Surgery

ANTHEM-CG-SURG-128, Presbyopia and Astigmatism-Correcting Intraocular Lenses

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)

CIGNA-0125, Intraocular Lens Implant

`V2788`, Presbyopia correcting function of intraocular lens

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

V2788, Presbyopia correcting function of intraocular lens

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`V2788`, Presbyopia correcting function of intraocular lens