Does H35.369 require prior authorization?

No, H35.369 does not require prior authorization (high confidence). Covered without prior authorization.

`H35.369`, Drusen (degenerative) of macula, 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.
None. (This Clinical Policy Bulletin addresses laser photocoagulation of drusen and finds the procedure experimental and investigational for the prevention and treatment of age-related macular degeneration.)
Visual field examination is covered for patients with inflammation or disorders of the eyelids that may affect the visual field.
Visual field examination is covered for patients with a documented diagnosis of glaucoma.
Visual field examination is covered for glaucoma suspects, defined by increased intraocular pressure, inter-eye intraocular pressure asymmetry greater than 2–3 mm Hg, or optic nerve findings suspicious for glaucoma (asymmetric cupping, disc hemorrhage, absent or thinned temporal rim).
Visual field examination is covered for patients with a documented disorder of the optic nerve, neurologic visual pathway, or retina.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0609, Laser Photocoagulation of Drusen

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