Does H15.129 require prior authorization?

No, H15.129 does not require prior authorization (high confidence). Covered without prior authorization.

`H15.129`, Nodular episcleritis, unspecified eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Inferred: for evaluations labeled as 'once' (evaluation of complications of corneal refractive surgery; testing for glaucoma suspects once per lifetime), documentation should record date(s) of prior pachymetry to substantiate frequency limits.
Inferred: for persons 'who recently had laser iridotomy' documentation of prior laser iridotomy and reason for testing should be present.
Inferred: for corneal transplant pre- and post-operative evaluations and for evaluation of corneal rejection, medical/surgical records documenting transplant status, signs/symptoms of rejection, and treatment/response should be included.
Inferred: clinical documentation must support one of the covered indications/diagnoses listed in the policy (e.g., documentation of corneal disease for pre-operative cataract work-up to justify pachymetry).

Fuchs' endothelial dystrophy
Persons who recently had laser iridotomy for the treatment of narrow angle glaucoma (also known as acute angle-closure glaucoma or closed-angle glaucoma)
Anatomical narrow angles
Bullous keratopathy
Corneal edema
Corneal refractive surgery (pre- and post-operative evaluation)

AETNA-CPB-0681, Corneal Pachymetry

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

AETNA-CPB-0734, External Ocular Photography

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