Does H26.499 require prior authorization?

No, H26.499 does not require prior authorization (high confidence). Covered without prior authorization.

`H26.499`, Other secondary cataract, 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.
YAG laser posterior capsulotomy is consideredmedically necessaryforanyof the following:
For individuals with posterior capsular opacification whenallof the following criteria are met:The opacification is causing symptomatic impairment of visual function not correctable with a tolerable change in glasses or contact lenses;andVision loss interferes with one or more of the following: reading, viewing television, driving, meeting vocational or recreational needs, or other daily activities;andOther eye disease(s), have been ruled out as the primary cause of decreased visual function inc [...]
The opacification is causing symptomatic impairment of visual function not correctable with a tolerable change in glasses or contact lenses;and
Vision loss interferes with one or more of the following: reading, viewing television, driving, meeting vocational or recreational needs, or other daily activities;and
Other eye disease(s), have been ruled out as the primary cause of decreased visual function including, but not limited to macular degeneration or diabetic retinopathy;and

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

ANTHEM-CG-SURG-114, Ophthalmic use of Nd:YAG Laser for Posterior Capsulotomy

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