Does H05.049 require prior authorization?

No, H05.049 does not require prior authorization (high confidence). Covered without prior authorization.

`H05.049`, Tenonitis of unspecified orbit

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information such as complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Retisert (fluocinolone acetonide intravitreal 0.59 mg implant) and Yutiq (fluocinolone acetonide intravitreal 0.18 mg implant) for the treatment of chronic non-infectious uveitis (including birdshot chorioretinopathy) affecting the posterior segment of the eye in persons who do not respond to or are intolerant to conventional treatment (i.e., failed corticosteroid or immunosuppressive therapy);
Iluvien (fluocinolone acetonide intravitreal implant) for the treatment of diabetic macular edema in persons who have been previously treated with a course of corticosteroids and did not have a clinically significant rise in intraocular pressure.
Retisert: FDA approved ... for the treatment of chronic non-infectious uveitis affecting the posterior segment of the eye.
On October 16, 2018, the FDA approved Yutiq, an intravitreal 0.18 mg fluocinolone acetonide implant for patients with chronic noninfectious posterior uveitis.
For the treatment of diabetic macular edema: Iluvien (0.19 mg fluocinolone acetonide): Inject 1 implant (containing 0.19 mg fluocinolone acetonide) intravitreally.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0719, Fluocinolone Acetonide Intra-vitreal Implant (Retisert, Yutiq and Iluvien)

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