Does E10.319 require prior authorization?

No, E10.319 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`E10.319`, Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Claims must be submitted in accordance with CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 32 Section 150 (Billing Requirements for Bariatric Surgery for Morbid Obesity), including use of the procedure and diagnosis codes listed there and in this local article.
Coverage for Type II diabetes mellitus complication diagnosis codes is based on the Internet Only Manual (IOM); include documentation and citations required by IOM when billing these diagnoses.
Bariatric surgery claims must reference the applicable national coverage determination (CMS Pub 100-03 Chapter 1 Part 2 Section 100.1) when submitting for payment.

Key Coverage Criteria

Bariatric surgery for treatment of co-morbid conditions related to morbid obesity is payable when billed in accordance with CMS Pub 100-03 Medicare National Coverage Determinations Manual, Chapter 1 Part 2 Section 100.1.
Additional diagnoses listed in this local coverage article for Part A procedure codes and the article's listed CPT codes are covered for bariatric surgery to treat co-morbid conditions related to morbid obesity.
Foot care services are covered when the beneficiary has a listed systemic condition that justifies coverage per Medicare Benefit Policy Manual Pub.100-02, Ch.15, Section 290.4D.
For diagnosis codes designated by an asterisk, the patient must be under the active care of an M.D. or D.O., documented as having been seen for the complicating disease within the 6 months prior to service.
Claims asserting presumptive coverage must include a systemic-condition diagnosis from IOM 100-02 Ch.15 Section 290 Group 1 and a valid billing modifier Q7, Q8, or Q9.
Mycotic nail debridement is covered when mycotic nails are present in the context of a systemic disease with class findings and the appropriate Q modifier on the claim.

20 Active Policies

CGS-J15-L37578, Micro-Invasive Glaucoma Surgery (MIGS)

J15

CGS-J15-L38662, Implantable Continuous Glucose Monitors (I-CGM)

J15

CGS-J15-L33954, Cataract Extraction

J15

CGS-J15-L38992, Electroretinography (ERG)

J15

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

J15

CGS-J18-L37578, Micro-Invasive Glaucoma Surgery (MIGS)

J18

CGS-J18-L38662, Implantable Continuous Glucose Monitors (I-CGM)

J18

CGS-J18-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J18

CGS-J18-L34246, Routine Foot Care and Debridement of Nails

J18

CGS-J18-L33954, Cataract Extraction

J18

CGS-J18-L38992, Electroretinography (ERG)

J18

WPS-J5-L34760, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A56232, Billing and Coding: Foot Care

WPS-J5-L38686, Implantable Continuous Glucose Monitors (I-CGM)

WPS-J5-L35490, Category III Codes

A54923, Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity

WPS-J5-L37015, Visual Electrophysiology Testing

A56916, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A57599, Billing and Coding: Visual Electrophysiology Testing

`E10.319`, Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

E10.319, Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`E10.319`, Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema