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ICD-10-CM Z87.720, Personal history of (corrected) congenital malformations of eye | No Prior Auth

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`Z87.720`, Personal history of (corrected) congenital malformations of eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

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, Blepharoplasty, Blepharoptosis Repair, and Brow Lift

Related Codes

15820(1 policies)15821(1 policies)15822(1 policies)15823(1 policies)67900(1 policies)67901(1 policies)67902(1 policies)00103(1 policies)

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