Does H17.00 require prior authorization?

No, H17.00 does not require prior authorization (high confidence). Covered without prior authorization.

`H17.00`, Adherent leukoma, 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.
Correction of surgically induced astigmatism with a corneal relaxing incision (including limbal relaxing incisions) or corneal wedge resection when both of the following criteria are met: The member had previous penetrating keratoplasty (corneal transplant) within the past 60 months or cataract surgery within the last 36 months; AND both of the following criteria are met: The degree of astigmatism must be 3.00 diopters or greater; and The member must be intolerant of glasses or contact lenses.
Phototherapeutic keratectomy (PTK) is medically necessary for corneal scars and opacities (including post-traumatic, post-infectious, post-surgical, and secondary to pathology).
Phototherapeutic keratectomy (PTK) is medically necessary for epithelial membrane dystrophy.
Phototherapeutic keratectomy (PTK) is medically necessary for irregular corneal surfaces due to Salzmann's nodular degeneration or keratoconus nodules.
Phototherapeutic keratectomy (PTK) is medically necessary for recurrent corneal erosions when more conservative measures (e.g., lubricants, hypertonic saline, patching, bandage contact lenses, gentle debridement of severely aberrant epithelium) have failed to halt the erosions.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0023, Corneal Remodeling

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