Does H02.421 require prior authorization?

No, H02.421 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H02.421`, Myogenic ptosis of right eyelid

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

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-L34394, Visual Fields Testing

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L33944, Blepharoplasty

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L33944

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