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Needs Prior Authorization?
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Level of Service
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Patient Information
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Ordering Provider Info
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Referring to self? (Medical)
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Referring to self? (Surgical)
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New Field
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Needs CPT Codes?
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Est. Comprehensive - EYE
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Est. Intermediate - EYE
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HVF
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OCT RNFL
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Gonio
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OCT Macula
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Fundus Photos
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Pachymetry
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External Photos
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Depressed DFE - Initial
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IOL Master
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Depressed DFE - Subsequent
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A-Scan
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Punctal Plugs
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Probe and Irrigate
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Dilate and irrigate
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FB removal - embedded, subconj, sclera
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FB removal - Conj, external eye
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Corneal Scrapping
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FB removal - Cornea
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Intravitreal injection
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Bandage contact lens
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Subconj injection
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AC Paracentesis
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Epiliation
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AC Injection
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Chalazion excision, multiple, same lid
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Chalazion excision
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Drainage of conjunctiva/eyelid cyst
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Chalazion excision, both lids, one eye
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Eyelid lesion removal
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Drainage of abscess
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Cataract Surgery
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Pterygium excision with graft
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SLT/ALT
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Complicated Cataract Surgery
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YAG Capsulotomy
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Glaucoma drainage implant
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Focal Laser
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LPI
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Other
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Laser Iridoplasty
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PRP
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Other
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