Does H34.219 require prior authorization?

No, H34.219 does not require prior authorization (high confidence). Covered without prior authorization.

`H34.219`, Partial retinal artery occlusion, 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.
Non-invasive extracranial arterial studies are covered only when the service meets all clinical indications and limitations specified in LCD L33695 and all applicable CMS national coverage determinations and Medicare medical necessity requirements.
Evaluation is covered for patients with vasculitis involving the extracranial carotid arteries.
Evaluation is covered for patients with proven carotid disease on medical management whose cerebrovascular symptoms become recurrent.
Evaluation is covered for patients presenting with carotid artery injury or blunt neck trauma.
Initial non-invasive extracranial arterial study is covered for an asymptomatic carotid bruit identified on physical examination.

FIRST_COAST-L33695, Non-invasive Extracranial Arterial Studies

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

A57670, Billing and Coding: Non-invasive Extracranial Arterial Studies

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