Does H26.411 require prior authorization?

No, H26.411 does not require prior authorization (high confidence). Covered without prior authorization.

`H26.411`, Soemmering's ring, right eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical record must include the ordering provider's assessment related to the patient's complaint for that visit, relevant medical history, and results of pertinent diagnostic tests or procedures.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.
When an ABN is used, Form CMS-R-131 should be signed by the beneficiary; for claims submitted to the Part A MAC, occurrence code 32 and the ABN date are required.
Claims for capsulotomy within three months of cataract surgery must include clear documentation justifying the need for the procedure (e.g., significant visual debility or listed risk factors).

Posterior capsular opacification (ACO/PCO) after cataract surgery causing significant visual debility is an indication for capsulotomy (YAG laser or discission).
Capsulotomy performed less than 3 months after cataract surgery is covered only when documented indications exist (examples: preoperative uveitis, chronic glaucoma, diabetes mellitus, prolonged pilocarpine use, or significant visual debility).
Repeat capsulotomy on the same eye (during the same or separate episode of care) is covered if the medical record contains a clear rationale and documented indications for the repeat procedure.
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.
Complex cataract extraction is covered when the procedure requires insertion of iris retractors through additional incisions to maintain or improve exposure.

CGS-J15-L33946, Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy

J15

CGS-J18-L33946, Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy

J18

WPS-J5-L39905, Cataract Surgery

A59805, Billing and Coding: Cataract Surgery

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