Does H18.20 require prior authorization?

No, H18.20 does not require prior authorization (high confidence). Covered without prior authorization.

`H18.20`, Unspecified corneal edema

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
When both procedures are performed, append modifier 59 and provide clear medical record documentation explaining the clinical necessity and how the services are distinct.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
When distinct clinical circumstances require both SCODI (CPT 92133 or 92134) and fundus photography (CPT 92250) to evaluate or treat the patient, both procedures may be reported together with modifier 59 to indicate a distinct procedural service.
SCODI (CPT 92133, 92134) is considered medically reasonable and necessary for evaluation of retinal disorders, glaucoma, and anterior segment disorders as documented in LCD L34760.
Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J18-L34393, Ocular Photography - External

J18

A56916, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A57483, Billing and Coding: Visual Fields

WPS-J5-L34615

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