65436 CPT® code: payer coverage and prior authorization6 of 6 payer prior-auth lists that name 65436 require prior authorization or set conditions: Neighborhood Health Partnership, Oxford Health Plans, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | site of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WI | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| Oxford Health Plans | Oxford Health Plans | All | prior auth under conditions | site of care: outpatient hospital | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth under conditions | site of care: outpatient hospital; not in AK, GU, IL, MA, PR, RI, TX, UT, VI, WI | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth under conditions | site of care: outpatient hospital | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth under conditions | site of care: outpatient hospital | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth under conditions | site of care: outpatient hospital; not in AK, IL, MA, PR, RI, TX, UT, VI, WI | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 |
65436 appears in 4 coverage policies from Aetna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Corneal Graft and Amniotic Membrane Transplantation, Corneal Stromal Lenticule Transplantation, Limbal Stem Cell Transplantation, or Sural Nerve Grafting for Ocular Indications (0293) | listed, no stance | Jun 8, 2026 | payer document |
| Aetna | Corneal Remodeling (0023) | listed, no stance (range 65400-65600) | Oct 9, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Phototherapeutic Keratectomy (SUR713.023) | listed, no stance | Jan 1, 2026 | payer document |
| Regence | Surgical Site of Care – Hospital Outpatient (Utilization Management 19) | listed, no stance | May 1, 2026 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.