Does H18.513 require prior authorization?

No, H18.513 does not require prior authorization (high confidence). Covered without prior authorization.

`H18.513`, Endothelial corneal dystrophy, bilateral

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.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
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.
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.
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.

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J15-L33999, Corneal Pachymetry

J15

CGS-J18-L33999, Corneal Pachymetry

J18

CGS-J18-L34393, Ocular Photography - External

J18

A57483, Billing and Coding: Visual Fields

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