65778 CPT® code: payer coverage and prior authorization7 of 7 payer prior-auth lists that name 65778 require prior authorization or set conditions: Humana, Neighborhood Health Partnership, Oxford Health Plans, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Humana Healthy Horizons | OK | prior auth required | Jan 1, 2027 | Humana Healthy Horizons® in Oklahoma Prior Authorization Notification List (PAL) The following preauthorization and notification list | |
| 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 |
65778 appears in 10 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| 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) | covered if criteria are met | Jun 8, 2026 | payer document |
| Aetna | Dry Eyes (0457) | not covered | Jul 29, 2026 | payer document |
| Aetna | Strabismus Repair (0566) | not covered (range 65778-65779) | Aug 6, 2026 | payer document |
| Anthem | Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses (CG-SURG-127) | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Amniotic Membrane And Amniotic Fluid (A.7.01.149) | listed, no stance | payer document | |
| Blue Cross Blue Shield of Massachusetts | Amniotic Membrane and Amniotic Fluid (643) | covered if criteria are met | payer document | |
| Blue Cross NC | Amniotic Membrane and Amniotic Fluid Injections for Ophthalmic Indications | listed, no stance | Jun 1, 2026 | payer document |
| Blue Shield of California | | Amniotic Membrane and Amniotic Fluid (7.01.149) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Amniotic Membrane and Amniotic Fluid (CAM 701149) | listed, no stance | Aug 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Amniotic Membrane and Amniotic Fluid (SUR704.011) | listed, no stance | Dec 15, 2025 | payer document |
Prior authorization required or conditional in NE.
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.