Does H35.719 require prior authorization?

No, H35.719 does not require prior authorization (high confidence). Covered without prior authorization.

`H35.719`, Central serous chorioretinopathy, 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.
ICD-10 codes covered if selection criteria are met: C69.20 - C69.22 Malignant neoplasm of retina; C69.30 - C69.32 Malignant neoplasm of choroid.
ICD-10 codes covered if selection criteria are met: C69.30 - C69.32 Malignant neoplasm of choroid
Retinoblastoma involving less than 50 % of the retina, and without associated vitreal or subretinal seeds at the time of thermotherapy;
Aetna considers transpupillary thermotherapy (thermal therapy) medically necessary for either of the following indications:
Small (2 to 3 mm) choroidal melanomas located posterior in the globe.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0490, Transpupillary Thermal Therapy

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

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