Does H35.3130 require prior authorization?

No, H35.3130 does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`H35.3130`, Nonexudative age-related macular degeneration, bilateral, stage unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Key Coverage Criteria

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
Fundus photography is covered when medical necessity is documented in the medical record, including relevant history, exam, diagnostic test results, and retention of the photographs and an interpretation/report.
Extended ophthalmoscopy is covered when medical necessity is documented for each eye, including relevant history, physical exam, pertinent diagnostic results, and retinal drawings that meet the policy specifications.
Patients actively receiving intravitreal injections for exudative age-related macular degeneration (ICD H35.3210-H35.3213, H35.3220-H35.3223, H35.3230-H35.3233) may require and are covered for extended ophthalmoscopy.
Conditions including tuberculosis of eye (A18.53, A18.54), diabetes mellitus with ophthalmic complications (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359), ophthalmia nodosa (H16.241-H16.249), selected anterior segment disorders (H20.00-H21.1X1), and transient cerebral ischemic attacks with ocular involvement (G45.3) may require extended ophthalmoscopy and are covered.
Malignant and secondary neoplasms of the eye and adnexa (C69.20-C69.42, C79.89-C79.9) and benign neoplasms of the eye and adnexa (D31.20-D31.32) may require and are covered for extended ophthalmoscopy.

20 Active Policies

CGS-J15-L38992, Electroretinography (ERG)

J15

CGS-J18-L38992, Electroretinography (ERG)

J18

A57599, Billing and Coding: Visual Electrophysiology Testing

A56916, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

WPS-J5-L34760, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

WPS-J5-L37015, Visual Electrophysiology Testing

NGS-J6-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A57060, Billing and Coding: Visual Electrophysiology Testing

NGS-J6-L33574, Visual Fields Testing

NGS-J6-L36831, Visual Electrophysiology Testing

A56726, Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

A56551, Billing and Coding: Visual Fields Testing

A56537, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

NGS-J6-L33567, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

WPS-J8-L37015, Visual Electrophysiology Testing

WPS-J8-L34760, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

FIRST_COAST-L33766, Visual Field Examination

FIRST_COAST-L33751, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

FIRST_COAST-L37398, Electroretinography (ERG)

A57637, Billing and Coding: Visual Field Examination

`H35.3130`, Nonexudative age-related macular degeneration, bilateral, stage unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

H35.3130, Nonexudative age-related macular degeneration, bilateral, stage unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`H35.3130`, Nonexudative age-related macular degeneration, bilateral, stage unspecified