CommercialAdministrativeLow impact
11.05.07d, Surgical Correction of Strabismus
Independence Blue Cross·PA · Ophthalmology, Pediatrics·Medical Policy
We identified it
Jul 23, 2026
Summary
This is a routine annual reissuance of Independence Blue Cross policy 11.05.07d on surgical correction of strabismus with no substantive changes to coverage criteria, billing codes, or medical necessity requirements. The policy maintains existing coverage for strabismus surgery in children ≤10 years and adults >10 years meeting specific clinical criteria.
Action Required
No immediate action required. This is a reissuance with no changes to the existing policy. Billing team should confirm current documentation practices align with the medical necessity criteria (for patients >10 years: diplopia, abnormal head posture, visual confusion, impaired depth perception, failed other therapies, impaired peripheral vision from esotropia, or psychosocial/vocational improvement). Maintain current billing practices for CPT codes 67311-67331. Ensure all strabismus surgery claims include documentation supporting one of the stated medical necessity criteria.