Check prior authorization requirements for CPT 92020

Gonioscopy is referenced with CPT code 92020. Verify payer-specific coding and prior authorization rules for CPT 92020 before scheduling or submitting claims.

• CPT 92020 = Gonioscopy

Prior authorization not specified in this section

This section of the policy primarily lists diagnosis (ICD-10) codes related to gonioscopy and does not specify any prior authorization requirements. Confirm plan benefit documents for any prior authorization rules.

Policy guides medical necessity; plan determines prior authorization

This clinical policy is intended as a guide to medical necessity to assist coverage decisions and benefit administration; prior authorization requirements are determined by the Health Plan and related benefit documents.

Document clinical indication supporting gonioscopy

Ensure any requested service aligns with the medical necessity indications in the policy (e.g., glaucoma, trauma, hyphema, rubeosis) and document the clinical indication in the medical record.

Document diagnosis code(s) and laterality on claim

If performing gonioscopy, record laterality and the specific diagnosis code(s) that justify the procedure from the listed ICD-10 codes in the policy when submitting claims.

Verify member coverage and obtain prior authorization if required

Before submission, confirm that the patient’s coverage and any plan-level requirements permit gonioscopy for the documented indication; obtain prior authorization if required by the plan.

Document corneal assessment and procedural preparation

Prior to performing gonioscopy, assess corneal integrity using fluorescein, administer topical anesthesia, prepare the goniolens, and recheck the cornea after lens removal; document these steps in the medical record.

• Determine corneal integrity with fluorescein prior to gonioscopy
• Use topical anesthesia and prepare the goniolens
• Irrigate and recheck the cornea after lens removal

Include clinical rationale and follow plan submission rules

Follow plan-specific submission requirements (e.g., prior authorization, modifier usage, documentation) and include clinical rationale in records to support medical necessity for review.

Follow plan and state/federal compliance requirements

Adhere to Health Plan-level administrative policies and applicable state and federal requirements; for Medicaid members, state Medicaid coverage provisions take precedence when they conflict with this policy.

Codes listed are informational — verify current coding guidance

Inclusion or exclusion of codes in this policy does not guarantee coverage. Providers must reference the most current professional coding guidance and payer rules before submitting claims.

No explicit denial triggers listed here — nonconformance may still cause denial

This excerpt lists diagnosis codes associated with gonioscopy but does not provide explicit denial triggers; however, failure to follow coverage documents or plan rules may result in denial.

Denial risk if coverage documents or plan rules are not followed

Coverage decisions and benefit administration are subject to all terms, conditions, exclusions and limitations of the member’s coverage documents; failure to follow these may lead to claim denial.