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PAYER POLICY CHANGES

92136 Insurance Policy Changes

CPT 92136, in plain terms, covers Measurement of eye length and optics by optical (partial coherence) interferometry, with calculation of lens implant power before cataract surgery. Ultrasound biometry uses a different code. CPT 92136 is referenced in 2 tracked payer policy changes from Aetna Better Health of Virginia and Utah Medicaid. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92136 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 92136 on AAPC

Watch 92136

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter Health of Delaware CMS-0057-F prior authorization requirements

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 92136?

Ambetter lists 92136 on Ambetter Health of Delaware CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 92136?

CalViva Health lists 92136 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for 92136?

Centene lists 92136 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 92136?

Community Health Plan of Imperial Valley lists 92136 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 92136?

There are 2 tracked policy changes affecting CPT 92136, including updates from Aetna Better Health of Virginia, Utah Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 92136?

Payers that have issued tracked updates for CPT 92136 include: Aetna Better Health of Virginia, Utah Medicaid.

How do I get notified when CPT 92136 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 92136. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 92136?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 92136

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 92136 in one place.

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