Clinical Policy Directory

• Adult Strabismus Surgery 1311 effect 4.2024.pdf
• Adult Strabismus Surgery 1311 effect 4.2024 SPANISH.pdf
• Amniotic Membrane 1312 effect 5.2024.pdf
• Amniotic Membrane 1312 effect 5.2024 SPANISH.pdf
• Botulinum Toxin 1325 effect 7.2024.pdf
• Botulinum Toxin 1325 effect 7.2024 SPANISH.pdf
• Cataract Surgery 1300 effect 4.2024.pdf
• Cataract Surgery 1300 effective 4.2024 SPANISH.pdf
• Complement Inhibitors for Geographic Atrophy 1349 effect 1.2024.pdf
• Complement Inhibitors for Geographic Atrophy 1349 effect 1.2024 SPANISH.pdf
• Complement Inhibitors for Geographic Atrophy 1349 effect 11.2024.pdf
• Complement Inhibitors for Geographic Atrophy 1349 effect 11.2024 SPANISH.pdf
• Corneal Pachymetry 1307 effect 6.2024.pdf
• Corneal Pachymetry 1307 effect 6.2024 Spanish.pdf
• Corneal Topography 1314 effect 4.2024.pdf
• Corneal Topography 1314 effect 4.2024 Spanish.pdf
• Corticosteroid Implants and Injections 1346 effect 10.1.2024.pdf
• Corticosteroid Implants and Injections 1346 effect 10.2024 SPANISH.pdf
• Corticosteroid Implants and Injections 1346 effect 5.1.2024.pdf
• Corticosteroid Implants and Injections 1346 effect 5.2024 SPANISH.pdf
• Dextenza dexamethasone intracanalicular insert 1348 effect 6.2024.pdf
• Dextenza dexamethasone intracanalicular insert 1348 effect 6.2024 SPANISH.pdf
• Durysta bimatoprost implant 1343 effect 5.2024.pdf
• Durysta-bimatoprost implant 1343 effect 5.2024 SPANISH.pdf
• Electrophysiology Testing 1334 effect 9.2023.pdf
• Electrophysiology Testing 1334 effec 9.2023 Spanish.pdf
• Electrophysiology Testing 1334 effect 10.2024.pdf
• Electrophysiology Testing 1334 effect 10.2024 SPANISH.pdf
• Experimental and Investigational Services 1323 effect 7.2024.pdf
• Experimental and Investigational Services 1323 effect 7.2024 SPANISH.pdf
• Extended Ophthalmoscopy 1335 effect 10.1.2023.pdf
• Extended Ophthalmoscopy 1335 effect 10.2023 Spanish.pdf
• Extended Ophthalmoscopy 1335 effect 9.1.2024.pdf
• Extended Ophthalmoscopy 1335 effect 9.2024 Spanish.pdf
• External Ocular Photography 1338 effect 9.2023.pdf
• External Ocular Photography 1338 effect 9.2023 SPANISH.pdf
• External Ocular Photography 1338 effect 9.2024.pdf
• External Ocular Photography 1338 effect 9.2024 SPANISH.pdf
• Eye Exams 1316 effect 6.2024.pdf
• Eye Exams 1316 effect 6.2024 SPANISH.pdf
• Eyelid Lesion Removal 1321 effect 10.1.2023.pdf
• Eyelid Lesion Removal 1321 effect 10.2023 SPANISH.pdf
• Eyelid Lesion Removal 1321 effect 11.1.2024.pdf
• Eyelid Lesion Removal 1321 effect 11.2024 SPANISH.pdf
• Eyelid and Brow Surgery 1301 effect 4.2024.pdf
• Eyelid and Brow Surgery 1301 effect 4.2024 SPANISH.pdf
• Fundus Photography 1331 effect 9.2023.pdf
• Fundus Photography 1331 effect 9.2023 SPANISH.pdf
• Fundus Photography 1331 effect 9.1.2024.pdf
• Fundus Photography 1331 effect 9.2024 SPANISH.pdf
• Glaucoma Surgery 1327 effect 7.2024.pdf
• Glaucoma Surgery 1327 effect 7.2024 Spanish.pdf
• Iris Prosthesis 1340 effect 10.1.2023.pdf
• Iris Prosthesis 1340 effect 10.2023 SPANISH.pdf
• Iris Prosthesis 1340 effect 9.1.2024.pdf
• Iris Prosthesis 1340 effect 9.2024 SPANISH.pdf
• Keratoconus and Related Corneal Ectasias 1328 effect 7.2024.pdf
• Keratoconus and Related Corneal Ectasias 1328 effect 7.2024 SPANISH.pdf
• Keratoplasty Keratectomy Corneal Transplant 1315 effect 5.2024.pdf
• Keratoplasty Keratectomy Corneal Transplant 1315 effect 5.2024 SPANISH.pdf
• Laser Peripheral Iridotomy 1322 effect 7.2024.pdf
• Laser Peripheral Iridotomy 1322 effect 7.2024 SPANISH.pdf
• Laser Photocoagulation of Retina 1326 effect 10.2023.pdf
• Laser Photocoagulation of Retina 1326 effect 10.2023 Spanish.pdf
• Laser Photocoagulation of Retina 1326 effect 10.2024.pdf
• Laser Photocoagulation of Retina 1326 effect 10.2024 Spanish.pdf
• Laser Trabeculoplasty 1308 effect 9.2024.pdf
• Laser Trabeculoplasty 1308 effect 1.2024.pdf
• Laser Trabeculoplasty 1308 effect 9.2024 Spanish.pdf
• Laser Trabeculoplasty 1308 effect 1.2024 Spanish.pdf
• Low Vision Eval and Rehab 1318 effect 7.2024.pdf
• Low Vision Eval and Rehab 1318 effect 7.2024 SPANISH.pdf
• Medically Necessary Contact Lenses 1309 effect 1.1.2024.pdf
• Medically Necessary Contact Lenses 1309 effect 1.2024 SPANISH.pdf
• Medically Necessary Contact Lenses 1309 effect 11.1.2024.pdf
• Medically Necessary Contact Lenses 1309 effect 11.2024 SPANISH.pdf
• Meibomian Gland Diagnostics and Therapies 1341 effect 10.2023.pdf
• Meibomian Gland Diagnostics and Therapies 1341 effect 10.2023 SPANISH.pdf
• Meibomian Gland Diagnostics and Therapies 1341 effect 9.1.2024.pdf
• Meibomian Gland Diagnostics and Therapies 1341 effect 9.2024 SPANISH.pdf
• Optical Coherence Tomography 1304 effect 6.2024.pdf
• Optical Coherence Tomography 1304 effect 6.2024 Spanish.pdf
• Perimetry Visual Field Testing 1319 effect 9.1.2023.pdf
• Perimetry Visual Field Testing 1319 effect 9.2023 SPANISH.pdf
• Perimetry Visual Field Testing 1319 effect 9.1.2024.pdf
• Perimetry Visual Field Testing 1319 effect 9.2024 SPANISH.pdf
• Posterior Capsulotomy 1305 effect 7.2024.pdf
• Posterior Capsulotomy 1305 effect 7.2024 SPANISH.pdf
• Pterygium Surgery 1329 effect 7.2024.pdf
• Pterygium Surgery 1329 effect 7.2024 SPANISH.pdf
• Refraction 1310 effect 4.2024.pdf
• Refraction 1310 effect 4.2024 SPANISH.pdf
• Refractive Surgery 1333 effect 6.2024.pdf
• Refractive Surgery 1333 effect 6.2024 Spanish.pdf
• Retinal Angiography 1313 effect 4.2024.pdf
• Retinal Angiography 1313 effect 4.2024 SPANISH.pdf
• Specialty Spectacle Lenses 1330 effect 7.2024.pdf
• Specialty Spectacle Lenses 1330 effect 7.2024 SPANISH.pdf
• Telemedicine 1336 effect 10.1.2023.pdf
• Telemedicine 1336 effect 10.2023 SPANISH.pdf
• Telemedicine 1336 effect 10.1.2024.pdf
• Telemedicine 1336 effect 10.2024 SPANISH.pdf
• Vascular Endothelial Growth Factor Inhibitors 1317 effect 10.1.2024.pdf
• Vascular Endothelial Growth Factor Inhibitors 1317 effect 10.2024 Spanish.pdf
• Vascular Endothelial Growth Factor Inhibitors 1317 effect 5.1.2024.pdf
• Vascular Endothelial Growth Factor Inhibitors 1317 effect 5.2024 SPANISH.pdf
• Verteporfin (Visudyne) 1345 effect 6.2024.pdf
• Verteporfin (Visudyne) 1345 effect 6.2024 Spanish.pdf
• Vision Therapy and Orthoptics 1337 effect 10.1.2023.pdf
• Vision Therapy and Orthoptics 1337 effect 10.2023 SPANISH.pdf
• Vision Therapy and Orthoptics 1337 effect 10.1.2024.pdf
• Vision Therapy and Orthoptics 1337 effect 10.2024 SPANISH.pdf