Does H26.219 require prior authorization?

No, H26.219 does not require prior authorization (high confidence). Covered without prior authorization.

`H26.219`, Cataract with neovascularization, unspecified eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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).

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: following cataract extraction.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: trauma to the eye which has damaged the lens.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: congenital cataract.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: congenital aphakia.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: lens subluxation/displacement.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

CIGNA-0125, Intraocular Lens Implant

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