Does H16.449 require prior authorization?

No, H16.449 does not require prior authorization (high confidence). Covered without prior authorization.

`H16.449`, Deep vascularization of cornea, unspecified eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information such as complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Keratoprosthesis using the Dohlman Doane Boston KPro (“Boston KPro”) device is consideredmedically necessaryfor the treatment of corneal blindness wheneitherof the following criteria are met (AorB):
For individuals with prior corneal transplant:The cornea is severely opaque and vascularized;andThere is documentation of at least one prior failed corneal transplant procedure;or
The cornea is severely opaque and vascularized;and
There is documentation of at least one prior failed corneal transplant procedure;or
There is documentation of the presence of a condition predisposing the individual to a high likelihood of corneal transplant failure, including but not limited toanyof the following:Autoimmune conditions with ocular involvement;orHeavily vascularized corneal scars;orLimbal stem cell compromise;orMucus membrane pemphigoid;orNeuropathic keratopathy;orOcular chemical burns;orOcular cicatricial pemphigoid;orPostherpetic anesthesia;orSevere dry eye;orStevens-Johnson Syndrome.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

ANTHEM-CG-SURG-94, Keratoprosthesis

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