Effective May 1, 2024: Removal of Prior Authorization Requirement for Certain Medical Eye Procedures
Date: 04/26/24
Effective May 1, 2024, Superior HealthPlan will no longer require prior authorization for certain medical eye procedures for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP, below are the Current Procedural Terminology (CPT) codes included in this change to the prior authorization requirements.
CPT Codes | Description |
15822 | BLEPHAROPLASTY UPPER EYELID |
67901 | REPR BLEPHAROPTOSIS; W/SUTUE/OTHER MAT |
67902 | REPR BLEPHAROPTOSIS; W/FASCIAL SLING |
67904 | REPR BLEPHAROPTOSIS; LEVATOR RESECT-EXT APPROACH |
67911 | CORRECT LID RETRACTION |
92004 | OPHTH SERV: MED EXAM; COMP NEW PT 1/MORE VISITS |
92014 | OPHTH SERV: MED EXAM & EVAL; COMP ESTAB PT |
92015 | DETERM REFRACTIVE STATE |
92019 | OPHTH EXAM & EVAL-GEN ANES; LTD |
92020 | GONIOSCOPY (SEPART PROC) |
92025 | COMPUTERIZED CORNEAL TOPOGRAPHY, UNI/BILATERAL, WITH INTERP AND REPORT |
92083 | VISUAL FIELD EXAM UNILAT/BILAT W/I&R; EXTEN |
92100 | SERIAL TONOMETRY (SEPART PROC) W/I&R SAME DA |
92133 | CMPTR OPHTH IMG OPTIC NERVE |
92134 | CPTR OPHTH DX IMG POST SEGM |
92136 | OPHTHALMIC BIOMETRY |
92228 | IMG RETINA DETCJ/MNTR DS REM PHYS/QHP I AND R UNI/BI |
92285 | EXT OCULAR PHOTOG W/I&R-DOCUMENT MED PROGRESS |
92310 | SCRIPT & FIT CONTACT LENS; CORNEAL EX APHAKIA |
V2623 | PROSTHETIC EYE PLASTIC CUSTOM |
To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.
For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.