Does H40.1413 require prior authorization?

No, H40.1413 does not require prior authorization (high confidence). Covered without prior authorization.

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`H40.1413`, Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
Services must be performed by or ordered/certified by ophthalmologists or optometrists or by authorized non-physician practitioners as allowed by state law, and that authority should be documented.

Key Coverage Criteria

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.
Coverage requires the test to be integral to the patient's medical management decision-making and performed by an ophthalmologist or optometrist.
When corneal disease is suspected and supported by diagnosis, pachymetry may be performed at the same time as endothelial cell count.

20 Active Policies

CGS-J15-L33999, Corneal Pachymetry

J15

CGS-J15-L40355, Anterior segment intraocular nonbiodegradable drug-eluting system

J15

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

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J15-L34181, Ophthalmic Biometry for Intraocular Lens Power Calculation

J15

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

J15

CGS-J15-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J15

CGS-J18-L34181, Ophthalmic Biometry for Intraocular Lens Power Calculation

J18

CGS-J18-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J18

CGS-J18-L33999, Corneal Pachymetry

J18

CGS-J18-L40355, Anterior segment intraocular nonbiodegradable drug-eluting system

J18

CGS-J18-L37578, Micro-Invasive Glaucoma Surgery (MIGS)

J18

CGS-J18-L34393, Ocular Photography - External

J18

CGS-J18-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J18

CGS-J18-L34394, Visual Fields Testing

J18

WPS-J5-L34615, Visual Fields

WPS-J5-L34760, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

WPS-J5-L37205, Chemotherapy Drugs and their Adjuncts

WPS-J5-L39907, Micro-Invasive Glaucoma Surgery (MIGS)

`H40.1413`, Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

H40.1413, Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`H40.1413`, Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage