Does H40.1194 require prior authorization?

No, H40.1194 does not require prior authorization (high confidence). Covered without prior authorization.

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`H40.1194`, Primary open-angle glaucoma, unspecified eye, indeterminate stage

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Medical record documentation by the ordering/referring physician must state the clinical indication/medical necessity for the test and include the test results.
If the performing provider is different from the ordering/referring physician, the performing provider must maintain hard copy test results and interpretation plus copies of the ordering/referring physician's order.

Key Coverage Criteria

Corneal pachymetry (measurement of corneal thickness) is covered to evaluate patients with a diagnosis of increased intraocular pressure.
Repeat corneal pachymetry is covered after interval corneal trauma or corneal surgery to reassess corneal thickness.
Corneal pachymetry is generally covered when performed as indicated by current medical literature or accepted standards of practice for clinical management.
Fundus photography is covered when medical necessity is documented in the medical record, including relevant history, exam, diagnostic test results, and retention of the photographs and an interpretation/report.
Extended ophthalmoscopy is covered when medical necessity is documented for each eye, including relevant history, physical exam, pertinent diagnostic results, and retinal drawings that meet the policy specifications.
Patients actively receiving intravitreal injections for exudative age-related macular degeneration (ICD H35.3210-H35.3213, H35.3220-H35.3223, H35.3230-H35.3233) may require and are covered for extended ophthalmoscopy.

17 Active Policies

A56548, Billing and Coding: Corneal Pachymetry

A56726, Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

NGS-J6-L33567, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

NGS-J6-L33574, Visual Fields Testing

NGS-J6-L33630, Corneal Pachymetry

A56551, Billing and Coding: Visual Fields Testing

A57637, Billing and Coding: Visual Field Examination

FIRST_COAST-L33766, Visual Field Examination

NGS-JK-L33567, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

NGS-JK-L33574, Visual Fields Testing

NGS-JK-L33630, Corneal Pachymetry

AETNA-CPB-0484, Glaucoma Surgery

ANTHEM-CG-SURG-118, Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)

ANTHEM-CG-SURG-125, Canaloplasty

AETNA-CPB-0622, Glaucoma Testing

AETNA-CPB-0293, Corneal Graft and Amniotic Membrane Transplantation, Corneal Stromal Lenticule Transplantation, Limbal Stem Cell Transplantation, or Sural Nerve Grafting for Ocular Indications

AETNA-CPB-0435, Viscocanalostomy and Canaloplasty

`H40.1194`, Primary open-angle glaucoma, unspecified eye, indeterminate stage

Prior Authorization

Documentation Required

Key Coverage Criteria

17 Active Policies

Related Codes

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H40.1194, Primary open-angle glaucoma, unspecified eye, indeterminate stage

Prior Authorization

Documentation Required

Key Coverage Criteria

17 Active Policies

Related Codes

Have a follow-up question?

`H40.1194`, Primary open-angle glaucoma, unspecified eye, indeterminate stage