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ICD-10-CM H10.811, Pingueculitis, right eye | No Prior Auth

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`H10.811`, Pingueculitis, right eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Interpretation and formal report must accompany the photographic study.
Clinical documentation in the medical record supporting the need for photographic documentation of medical progress.

Key Coverage Criteria

External ocular photography is medically necessary to track progression of external ocular conditions affecting the external eye, eyelids, and ocular adnexa.
Keratitis, corneal degeneration, dystrophy, injury, edema, ulceration, opacification, ectasia, or perforation
Iridocyclitis and associated glaucoma
Anterior chamber inflammation, hyphema, narrow angle, or synechiae
Conjunctivitis, episcleritis, or scleritis
Eyelid pathology (e.g., blepharitis, dermatitis, entropion, ectropion, ptosis, retraction, xanthelasma, chloasma, madarosis, edema, vascular abnormalities)

1 Active Policy

AMBETTER-CP.VP.43, External Ocular Photography

Related Codes

A18.51(1 policies)A18.52(1 policies)A18.54(1 policies)A50.31(1 policies)B00.51(1 policies)B00.52(1 policies)B00.53(1 policies)92285(1 policies)

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