66985 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 66985

2 of 2 payer prior-auth lists that name 66985 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.

PayerPlanStatePrior authConditionsSinceSource
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth under conditionssite of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WISep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth under conditionssite of care: outpatient hospitalSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026

Payer coverage policies that name 66985

66985 appears in 10 coverage policies from Aetna, Anthem, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

PayerPolicyRole in policyReviewedDocument
AetnaCataract Surgery (0508)
Femtosecond laser-assisted cataract surgery, capsular tension rings (e.g., StabilEyes)
covered if criteria are met (range 66830-66986)Oct 9, 2026payer document
AetnaCorneal Remodeling (0023)not coveredOct 9, 2026payer document
AetnaCritical Flicker Fusion (0860)listed, no stance (range 66830-66986)Dec 24, 2025payer document
AetnaDexamethasone Ophthalmic Implant (Ozurdex) and Insert (Dextenza) (0795)listed, no stanceOct 5, 2026payer document
AetnaGlaucoma Surgery (0484)listed, no stanceJul 14, 2026payer document
AetnaIntracameral Implants (1065)listed, no stance (range 66820-66991)Jun 30, 2026payer document
AnthemCataract Removal Surgery for Adults (CG-SURG-40)covered if criteria are metAug 13, 2026payer document
AnthemRefractive Surgery (CG-SURG-77)not coveredNov 6, 2025payer document
CignaIntraocular Lens Implant (0125)covered if criteria are metSep 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT) (SUR713.025)listed, no stanceJan 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Aug 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, Neighborhood Health Partnership
  • Jul 1, 2026: conditions changed, UnitedHealthcare

Medicaid fee-for-service

  • AZ: $932.80 (asc), effective Oct 1, 2026
  • CO: $630.55 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $524.38 (physician, non-facility), effective Jan 1, 2026
  • IL: $574.75 (practitioner), effective Jul 1, 2026
  • IN: $590.39 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $650.00 (asc, facility), effective Aug 1, 1982
  • KY: $1225.78 (asc), effective Jan 1, 2026
  • LA: $233.58 (asc), effective Jul 1, 2012
  • MA: $860.81 (asc), effective May 1, 2026
  • MS: $971.45 (comprehensive, facility), effective Oct 1, 2025
  • MT: $737.26 (optometric, facility), effective Jul 1, 2025
  • ND: $722.60 (physician, facility), effective Aug 1, 2026
  • NE: $1000.00 (asc), effective Jul 1, 2024
  • NY: $324.97 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $479.71 (physician), effective Jan 1, 2024
  • OK: $1118.31 (asc), effective Jan 1, 2026
  • TX: $849.94 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $570.60 (medical), effective Jul 1, 2026
  • VT: $1791.94 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1020.61 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

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.