Does H26.123 require prior authorization?

No, H26.123 does not require prior authorization (high confidence). Covered without prior authorization.

`H26.123`, Partially resolved traumatic cataract, bilateral

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must document relevant medical history, physical examination, indications for testing, an order for testing, test results, and the IOL power calculation; records must include patient name and date of service and be available to Medicare on request.
For diagnostic tests, report the result of the test if known; if the result is not available, report the symptoms that prompted the performance of the test.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
When separate technical and professional components are reported, appropriate modifiers must be used (e.g., -TC for technical, -26 for professional) and the professional component must include the anatomic modifier (-RT or -LT) to indicate the eye.

Ophthalmic biometry (CPT 76519 or 92136) is covered for preoperative intraocular lens (IOL) power calculation for patients undergoing cataract surgery.
Use diagnostic ultrasound A-scan (76519) for routine/simple cataract cases when performing IOL power calculation.
Use ultrasound B-scan (as clinically indicated) for patients with dense cataract where A-scan is not adequate for IOL power calculation.
Additional biometric testing beyond one scan is covered when there is an additional diagnosis beyond cataract and the medical need for the additional tests is fully documented.
Cataract extraction is covered when the physician performing the preoperative ophthalmologic evaluation lists cataract as the primary diagnosis (ICD-10-CM codes per LCD L35091).
Preoperative evaluation and management (E/M) services are covered when the evaluating clinician documents cataract as the primary or secondary diagnosis when medically necessary.

CGS-J15-L34181, Ophthalmic Biometry for Intraocular Lens Power Calculation

J15

CGS-J15-L37578, Micro-Invasive Glaucoma Surgery (MIGS)

J15

CGS-J15-L33954, Cataract Extraction

J15

CGS-J18-L34181, Ophthalmic Biometry for Intraocular Lens Power Calculation

J18

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