Does H35.079 require prior authorization?

No, H35.079 does not require prior authorization (high confidence). Covered without prior authorization.

`H35.079`, Retinal telangiectasis, 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.
Encelto is proven and medically necessary for the treatment of adults with idiopathic MacTel who meet all of the following for initial therapy: patient age >= 18; diagnosis confirmed in at least one eye; monitored for retinal tears/detachment signs; prescribed by an ophthalmologist; dosing per FDA labeling; authorization for no more than one treatment per eye per lifetime and not longer than 60 days from approval.
Photodynamic therapy (PDT) with light-activated verteporfin (Visudyne) medically necessary for the following indications:
- ICD-10 codes covered if selection criteria are met (examples listed): B39.4, B39.5, B39.9, D18.09, H32, H35.051 - H35.059, H35.30 - H35.3293, H35.711 - H35.719, H35.30 - H35.3293, H44.20 - H44.23, H44.2A1 - H44.2E9
Choroidal neovascularization - for treatment of predominantly classic subfoveal choroidal neovascularization (CNV) when both of the following criteria are met:
Member has predominantly classic subfoveal choroidal neovascularization due to one of the following: Age-related macular degeneration (AMD); or Pathologic myopia; or Prescumed ocular histoplasmosis; or Chronic central serous chorioretinopathy (also includes retinal pigment epithelial leakage without evident CNV); and The treatment spot size is less than or equal to 6.4 mm in diameter;

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

UHC-POL-encelto, Encelto (Revakinagene Taroretcel-Lwey)

AETNA-CPB-0594, Verteporfin (Visudyne) Photodynamic Therapy

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