Does H18.603 require prior authorization?

No, H18.603 does not require prior authorization (high confidence). Covered without prior authorization.

`H18.603`, Keratoconus, unspecified, 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.

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.
Computerized corneal topography is billable when performed as a diagnostic test for corneal conditions and the claim includes a diagnosis code that best describes the patient's condition for which the service was performed.
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.

CGS-J15-L34008, Computerized Corneal Topography

J15

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J15-L33999, Corneal Pachymetry

J15

CGS-J18-L34393, Ocular Photography - External

J18

CGS-J18-L33999

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