Does H10.413 require prior authorization?

No, H10.413 does not require prior authorization (high confidence). Covered without prior authorization.

`H10.413`, Chronic giant papillary conjunctivitis, bilateral

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Maintain all documentation in the patient's medical record and make it available to the contractor upon request.
Every page of the medical record must be legible and include patient identification information (e.g., full name, dates of service).
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) used for billing.

Allergen immunotherapy is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L36240.
Allergy testing is covered when the medical record documents a history indicating the possible presence of allergy and the clinician selected a minimal number of tests/antigens based on patient-specific history and physician examination.
Allergy testing is covered when the medical record documents the test(s) used, the interpretation(s), and objective measurement of reaction size (wheal and erythema in mm) or a standardized in vivo grading system.
Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J18-L34393, Ocular Photography - External

J18

CGS-J18-L40325, Allergy Diagnostic Testing

J18

WPS-J5-L36402

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