Payer policies › CPT 6731667316 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 67316 2 of 2 payer prior-auth lists that name 67316 require prior authorization or set conditions: Neighborhood Health Partnership, 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 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
Payer coverage policies that name 67316 67316 appears in 3 coverage policies from Aetna, Anthem.
Payer Policy Role in policy Reviewed Document Aetna Graves' Ophthalmopathy Treatments (0419) covered if criteria are met (range 67311-67343) Apr 23, 2026 payer document Aetna Strabismus Repair (0566) covered if criteria are met Aug 6, 2026 payer document Anthem Surgical Strabismus Correction (CG-SURG-41) covered if criteria are met Nov 6, 2025 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, Oxford Health Plans Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Community Plan 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, UnitedHealthcare Jul 1, 2026: conditions changed, Neighborhood Health Partnership Medicaid fee-for-service Prior authorization required or conditional in WA, WV.
AZ: $681.35 (asc), effective Oct 1, 2026 CO: $580.38 (chp_plus, non-facility), effective Jul 1, 2026 FL: $484.17 (physician, non-facility), effective Jan 1, 2026 IL: $511.90 (practitioner), effective Jul 1, 2026 IN: $546.50 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $450.00 (asc, facility), effective Aug 1, 1982 KY: $1062.47 (asc), effective Jan 1, 2026 LA: $217.00 (asc), effective Jul 1, 2012 MA: $711.40 (asc), effective May 1, 2026 MS: $820.80 (comprehensive, facility), effective Oct 1, 2025 MT: $680.65 (optometric, facility), effective Jul 1, 2025 ND: $626.33 (physician, facility), effective Aug 1, 2026 NE: $413.00 (asc), effective Jul 1, 2024 NY: $342.93 (physician_surgery, facility), effective Jul 1, 2026 OH: $547.41 (physician), effective Jan 1, 2024 OK: $969.31 (asc), effective Jan 1, 2026 TX: $698.30 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $516.49 (medical), effective Jul 1, 2026 VT: $1846.02 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $308.28 (asc), effective Jul 1, 2026 WY: $1051.41 (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.