Does H40.1114 require prior authorization?

No, H40.1114 does not require prior authorization (high confidence). Covered without prior authorization.

`H40.1114`, Primary open-angle glaucoma, right eye, indeterminate stage

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.
Medical records must document the diagnosis and clinical indication (e.g., increased intraocular pressure, Fuchs dystrophy, ocular trauma, surgical history) and that the pachymetry is integral to medical management.
Provider/supplier must notify the beneficiary in writing prior to rendering the service if the provider is aware the test may not be covered by Medicare.

Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
Corneal pachymetry is covered to determine the amount of endothelial trauma sustained during ocular surgery.
Corneal pachymetry is covered for pre-operative assessment of corneal health in patients with Fuchs dystrophy.
Corneal pachymetry is covered for assessment of corneal thickness after ocular trauma.
Corneal pachymetry is covered to assess corneal thickness in suspected glaucoma following a documented diagnosis of increased intraocular pressure prior to initiation of a glaucoma treatment regimen.

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L37578, Micro-Invasive Glaucoma Surgery (MIGS)

J15

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L33999, Corneal Pachymetry

J15

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