Does H40.069 require prior authorization?

No, H40.069 does not require prior authorization (high confidence). Covered without prior authorization.

`H40.069`, Primary angle closure without glaucoma damage, unspecified eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For Er:YAG laser for diffuse actinic cheilitis: biopsy results demonstrating no evidence of high-grade dysplasia or cancer.
Any use of procedures listed as covered 'if selection criteria are met' should be supported in the medical record by the specific clinical findings and measurements required by the selection criteria (e.g., BCVA, exam findings, symptom descriptions, prior treatments tried and failed).
For Nd:YAG posterior capsulotomy: documentation of eye exam confirming diagnosis of posterior capsular opacification and exclusion of other ocular causes of functional impairment (document: “The eye examination should confirm the diagnosis of posterior capsular opacification and exclude other ocular causes of functional impairment.”).
For cases of Nd:YAG capsulotomy performed within 6 months of cataract surgery: documentation/review demonstrating reasonableness and medical necessity because opacification is rare within first 6 months (document: “any cases of Nd:YAG laser capsulotomy occurring within 6 months of cataract surgery should be reviewed, to ensure that Nd:YAG laser capsulotomy is reasonable and medically necessary”).

Laser adjuncts / debridement for peri-implantitis and periodontal conditions
Er:YAG laser use for reductions in post-op pain/edema (e.g., third molar removal) and other oral/jaw conditions
Physical and laser therapies for genitourinary syndrome of menopause / vulvovaginal atrophy
Laser approaches to prevent posterior capsule opacification
Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women
Laser therapy for overactive bladder (non-ablative vaginal erbium:YAG) comparisons with pharmacotherapy

ANTHEM-CG-SURG-100, Laser Trabeculoplasty and Laser Peripheral Iridotomy

AETNA-CPB-0354, YAG Laser in Ophthalmology and Other Selected Indications

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