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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.46 Ophthalmology : 9.2.46.3 Eye Surgery by Incision

9.2.46.3
The following restrictions apply to vitrectomy and cataract surgeries:
Procedure codes 66500, 66505, 66605, 66625, 66630, and 66635 are denied as part of another procedure when billed with the following cataract surgeries: 65920, 66840, 66850, 66852, 66920, 66930, 66940, 66983, 66984, 66985, and 66986. Claims may be appealed with additional documentation to demonstrate the medical necessity.
For clients who are 8 years of age and younger, the following cataract extraction and vitrectomy procedure codes, performed on the same eye, will be considered for payment per multiple surgery guidelines:
 
 
 
Reimbursement for procedure codes 67041, 67042, and 67043 is limited to once every 90 days for the same eye.

Texas Medicaid & Healthcare Partnership
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