Does H35.389 require prior authorization?

No, H35.389 does not require prior authorization (high confidence). Covered without prior authorization.

`H35.389`, Toxic maculopathy, 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.
Screening diabetic retinopathy as an alternative to retinopathy screening by an ophthalmologist or optometrist (medical necessity per policy).
Screening retinopathy of prematurity as an alternative to retinopathy screening by an ophthalmologist or optometrist (medical necessity per policy).
CPT codes covered if selection criteria are met: 92227 (Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral) and 92228 (Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral).
HCPCS code related: S3000 (Diabetic indicator; retinal eye exam, dilated, bilateral) (listed as related to the CPB).
ICD-10 codes covered if selection criteria are met (Diabetes except with ophthalmic manifestations): E10.10 - E10.29; E10.40 - E10.9; E11.00 - E11.29; E11.40 - E11.9; E13.00 - E13.29; E13.40 - E13.9.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0563, Retinopathy Telescreening Systems

AETNA-CPB-0756, Epiretinal Radiation Therapy

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