|
6.3.41.2.1 Prior Authorization for Surgically or Trauma-Induced Astigmatism
Laser surgery of the eye for the purpose of correcting astigmatism may be considered for prior authorization in situations where the astigmatism was surgically or trauma-induced.
Procedure codes 65772 and 65775 must be used to submit prior authorization requests for the correction of surgically and trauma-induced astigmatism (diagnosis codes 36720, 36721, and 36722). Prior authorization requests, including documentation supporting medical necessity, may be faxed or mailed to the TMHP Special Medical Prior Authorization Department.
Medical necessity must include documentation that the degree of the astigmatism is 3.00 diopters or greater, the client is intolerant of glasses or contact lenses, and the appropriate criterion below:
• For surgically-induced astigmatism: The client has had previous penetrating keratoplasty (corneal transplant) within the past 60 months or cataract surgery within the last 36 months.
•For trauma-induced astigmatism: The mechanism of the trauma is indicated.
|
