December 2025
We updated the benefit summary for Washington to provide clarification on medically necessary medical and material services. Benefit coverage will remain unchanged.
All reviews will be performed through the claims process and a valid medical diagnosis is required for payment of any claims that are filed. The standards for diagnostic codes will be included in all medical procedure policies and readily available in our Provider Reference Guide.
You can still appeal claims and request clinical review of any contested claims. Our Peer Review Committee will review these requests to determine if they meet the requirements for medical necessity guidelines.
The updated procedures include the following:
| CPT® code(s) | Description |
|---|---|
| 68761 | Closure of Lacrimal Duct by Plug |
| 65778, V2790 | Amniotic Membrane Transplant |
| 92283 | Color Vision Extended Examination |
| 92025 | Computerized Corneal Topography |
| 76514 | Corneal Pachymetry |
| 76519, 92136 | Ophthalmic Biometry |
| 92201, 92202 | Extended Ophthalmoscopy |
| 92285 | External Ocular Photography |
| 92235, 92240 | Fluorescein Angiography (IVFA) |
| 92250 | Fundus Photography |
| 92020 | Gonioscopy |
| V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531 | Medically Necessary Contact Lenses |
| 76510, 76512, 76513 | Ophthalmic B-Scan |
| Post Cataract Surgery Materials | |
| 92132, 92133, 92134 | Scanning Computerized Ophthalmic Diagnostic Imaging |
| 92286 | Specular Microscopy |
| 92060, 92065 | Vision Therapy |
| 92081, 92082, 92083 | Visual Field Exam |
CPT® is a registered trademark of the American Medical Association.