Does H33.042 require prior authorization?

No, H33.042 does not require prior authorization (high confidence). Covered without prior authorization.

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`H33.042`, Retinal detachment with retinal dialysis, left eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When the service is performed in a hospital inpatient or outpatient setting, use modifier -26 to indicate the professional component.
Billing and coding must adhere to the coverage indications, limitations, and medical necessity criteria described in the associated LCD L34615 Visual Fields; follow that LCD for clinical eligibility and documentation requirements.
Prior to billing Medicare, verify applicable code combinations and correct coding guidelines with the CCI (Correct Coding Initiative).
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD.

Key Coverage Criteria

Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
Cataract causing impaired vision with documented symptomatic impairment of visual function that prevents satisfactory performance of activities of daily living (e.g., reading, driving); include the patient's chief complaint and a unique statement (patient's own words when possible) and record best-corrected Snellen visual acuity at distance (and near if applicable) by a careful refraction.
Cataract extraction when necessary to achieve an unimpeded view of the fundus or posterior segment to diagnose or manage posterior segment disease; when used in this circumstance bill the cataract diagnosis as primary and the posterior segment disease as secondary.

20 Active Policies

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

J15

CGS-J15-L33954, Cataract Extraction

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

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H33.042, Retinal detachment with retinal dialysis, left eye