Does H05.409 require prior authorization?

No, H05.409 does not require prior authorization (high confidence). Covered without prior authorization.

`H05.409`, Unspecified enophthalmos, unspecified eye

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.
Visual field examination is covered for patients with inflammation or disorders of the eyelids that may affect the visual field.
Visual field examination is covered for patients with a documented diagnosis of glaucoma.
Visual field examination is covered for glaucoma suspects, defined by increased intraocular pressure, inter-eye intraocular pressure asymmetry greater than 2–3 mm Hg, or optic nerve findings suspicious for glaucoma (asymmetric cupping, disc hemorrhage, absent or thinned temporal rim).
Visual field examination is covered for patients with a documented disorder of the optic nerve, neurologic visual pathway, or retina.
Visual field examination is covered for patients with a recent intracranial hemorrhage, intracranial mass, or recent measurement of increased intracranial pressure, with or without visual symptoms.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

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