Corneal surgical procedures (excluding corneal collagen cross-linking)
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Defines prior authorization requirements and medical necessity review criteria for corneal surgical procedures (other than corneal collagen cross-linking) for providers enrolled in the Connecticut Medical Assistance Program (HUSKY Health). Affects CMAP providers requesting authorization for listed corneal surgeries.
No material clinical or coverage changes in this revision.
Coverage Criteria
Medical necessity criteria for corneal surgical procedures
Prior authorization requests will be reviewed on a case-by-case basis and must meet the DSS definition of Medical Necessity.
Defined in document
Requests for these procedures will be reviewed case-by-case under the DSS Medical Necessity definition
This policy does not address corneal collagen cross-linking. Coverage and prior authorization for corneal collagen cross-linking are governed separately by the HUSKY Health Corneal Collagen Cross-linking medical policy and related InterQual® criteria as noted in HUSKY guidance.
Prior authorization decisions are made based on the DSS definition of Medical Necessity at the time the authorization is issued and reflect the clinical information submitted for that request. Authorization is not a guarantee of payment; actual payment depends on the member having active coverage, applicable benefits, and eligible policies in effect on the date of service.
Coding
| 65760 | Keratomileusis |
| 65765 | Keratophakia |
| 65770 | Keratoprosthesis |
| 65771 | Radial keratotomy |
| 65772 | Corneal relaxing incision for correction of surgically induced astigmatism |
| 65775 | Corneal wedge resection for correction of surgically induced astigmatism |
| 66999 | Unlisted procedure, anterior segment of eye |
| L8609 | Artificial Cornea |
| 65767 | Transplantation of donor corneal tissue |
Provider Actions and Requirements
Prior authorization required for listed corneal procedures
Prior authorization is required for the listed corneal surgical procedures and requests will be reviewed case-by-case using the DSS definition of Medical Necessity. Requests must follow the standard surgical prior authorization procedures and are effective for services on or after August 1, 2026.
Case-by-case review; authorization not a payment guarantee
Providers should note that coverage determinations are made on a case-by-case basis using submitted case-specific information and the DSS Medical Necessity definition; authorization is not a guarantee of payment.
- Requests are reviewed in accordance with standard procedures for surgical prior authorization.
Required submission materials and channels
Submit a fully completed authorization request either via the online web portal or by using the Outpatient Prior Authorization Request Form, and include documentation from the requesting physician supporting medical necessity; CHNCT may request additional information as needed.
- 1) Fully completed authorization request via online web portal OR
- 2) Fully completed Outpatient Prior Authorization Request Form
- 3) Documentation from the requesting physician supporting medical necessity
- 4) Any other information as requested by CHNCT
Incomplete documentation risks denial
Coverage determinations are based on the case-specific information you submit; failure to provide required documentation or a completed authorization form may result in denial or delay.
- Ensure all required forms and physician documentation are complete at time of submission to avoid denial or processing delays.
Background
Corneal surgical procedures include a range of operations performed to correct refractive errors, repair structural damage, reshape the cornea, and treat severe or sight‑threatening corneal disease. Examples include procedures such as keratomileusis, keratophakia, keratoprosthesis, corneal relaxing incisions, wedge resection, and radial keratotomy. This guidance is intended to assist CMAP providers with the information needed to support medical necessity determinations and prior authorization requests for corneal surgical procedures (excluding corneal collagen cross-linking).
Definitions
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