Does H18.461 require prior authorization?

No, H18.461 does not require prior authorization (high confidence). Covered without prior authorization.

`H18.461`, Peripheral corneal degeneration, right eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must include the ordering provider's assessment relevant to the patient's complaint for that visit.
The medical record must include relevant medical history related to the service.
The medical record must include results of pertinent tests and procedures; for diagnostic tests report the actual test result if known, otherwise report the symptoms prompting the test.
All office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.

Corneal pachymetry (measurement of corneal thickness) is covered to evaluate patients with a diagnosis of increased intraocular pressure.
Repeat corneal pachymetry is covered after interval corneal trauma or corneal surgery to reassess corneal thickness.
Corneal pachymetry is generally covered when performed as indicated by current medical literature or accepted standards of practice for clinical management.
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.

CGS-J15-L33999, Corneal Pachymetry

J15

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J18-L33999, Corneal Pachymetry

J18

CGS-J18-L34393, Ocular Photography - External

J18

A57483, Billing and Coding: Visual Fields

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