Skip to main content

ICD-10-CM H21.40, Pupillary membranes, unspecified eye | No Prior Auth

Backwork Sign up free

Ask Backwork/H21.40

`H21.40`, Pupillary membranes, unspecified eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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).

Key Coverage Criteria

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Laser adjuncts / debridement for peri-implantitis and periodontal conditions
Er:YAG laser use for reductions in post-op pain/edema (e.g., third molar removal) and other oral/jaw conditions
Physical and laser therapies for genitourinary syndrome of menopause / vulvovaginal atrophy
Laser approaches to prevent posterior capsule opacification
Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women

3 Active Policies

FIRST_COAST-L33766, Visual Field Examination

J9

A57637, Billing and Coding: Visual Field Examination

J9

AETNA-CPB-0354, YAG Laser in Ophthalmology and Other Selected Indications

Related Codes

H35.60(3 policies)H40.061(3 policies)H26.40(3 policies)H26.9(3 policies)H35.63(3 policies)H40.031(3 policies)H21.43(3 policies)H40.249(3 policies)

Have a follow-up question?

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

Ask Backwork about H21.40 Sign up free

The submitted CPT/HCPCS code must accurately describe the service performed.

If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation and retain copies of the ordering/referring physician’s order for the studies.