Does H16.331 require prior authorization?

No, H16.331 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H16.331`, Sclerosing keratitis, right eye

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted the test.
The patient medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.

Computerized corneal topography is billable when performed as a diagnostic test for corneal conditions and the claim includes a diagnosis code that best describes the patient's condition for which the service was performed.
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.
External ocular photography is medically necessary to track progression of external ocular conditions affecting the external eye, eyelids, and ocular adnexa.

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J15-L34008, Computerized Corneal Topography

J15

CGS-J18-L34008, Computerized Corneal Topography

J18

CGS-J18-L34393, Ocular Photography - External

J18

A57637

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