Does H02.142 require prior authorization?

No, H02.142 does not require prior authorization (high confidence). Covered without prior authorization.

`H02.142`, Spastic ectropion of right lower eyelid

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

List the appropriate CPT code for the procedure and include any applicable modifiers; adhere to Medicare global surgery and CCI (correct coding initiative) rules for eyelid surgeries.
Submit physicians' services and diagnostic tests with a diagnosis code that supports medical necessity and code to the greatest level of specificity (full digit completeness).
Use the diagnosis code based on diagnostic test results as the primary diagnosis; if test results are normal or inconclusive, use the diagnosis code for the sign or symptom that prompted the test as the primary diagnosis.
When signs or symptoms are present, place the appropriate definitive diagnosis code in the first position and an available symptom diagnosis code in the second position on CMS-1500 item 21 (or electronic equivalent).

Blepharoplasty, blepharoptosis repair, or brow lift is covered when documented signs or symptoms of a functional abnormality of the upper eyelids are present as defined by the associated LCD (L34528).
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.
EMG and/or nerve conduction studies are indicated for evaluation of suspected radiculopathy.
EMG and/or nerve conduction studies are indicated for evaluation of suspected mononeuropathy (single-nerve entrapment or injury).
EMG and/or nerve conduction studies are indicated for evaluation of suspected polyneuropathy or mononeuropathy multiplex.
EMG is indicated for evaluation of suspected myopathy.

CGS-J15-L33944, Blepharoplasty

J15

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J15-L39856, Botulinum Toxin Injections

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

Ask Backwork about documentation requirements, denial risks, or coverage in your state.