Does H16.101 require prior authorization?

No, H16.101 does not require prior authorization (high confidence). Covered without prior authorization.

`H16.101`, Unspecified superficial keratitis, right eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must document the ordering provider's assessment related to the patient's complaint prompting external ocular photography, including relevant medical history and physical exam findings supporting medical necessity.
All external ocular photographs must be permanently labeled with the patient's name, date, and notation of which eye is pictured, and copies must be available for Medicare review.
An interpretation and report specific to the photograph(s), including comparison to prior photographs when available, must be maintained in the medical record and available to the contractor upon request.
If additional photographs are taken to track changes, written documentation describing those changes must be maintained in the patient's medical record.

External ocular photography is covered when ordered by an authorized/referring provider to document, diagnose, or monitor an ocular condition and when medical record documentation supports medical necessity.
External ocular photographs are covered to track changes in a patient's ocular condition provided changes are documented in writing and compared to prior photographs when available.
Technical (TC) and professional (26) components of external ocular photography are payable under Part B when billed with the appropriate modifier and performed in allowable places of service as specified by Medicare.
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Assessment of anterior chamber angle (ACA) configuration and detection of occludable/angle-closure (anterior segment OCT (AS-OCT) may be used for assessment of the anterior chamber angle and as a rapid screening tool for detection of occludable angles; cited studies include Nolan et al. 2007, Pekmezci et al. 2009, Desmond et al. 2022)
None. (The CPB states anterior segment OCT is considered experimental and investigational for all indications; see Limitations below.)

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J18-L34393, Ocular Photography - External

J18

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0749

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