Does H40.1430 require prior authorization?

No, H40.1430 does not require prior authorization (high confidence). Covered without prior authorization.

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`H40.1430`, Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

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

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
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.

20 Active Policies

CGS-J15-L33999, Corneal Pachymetry

J15

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

J15

CGS-J18-L33999, Corneal Pachymetry

J18

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

J18

A56916, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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

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

A56551, Billing and Coding: Visual Fields Testing

NGS-J6-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A56537, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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

NGS-J6-L33574, Visual Fields Testing

NGS-J6-L33630, Corneal Pachymetry

A56548, Billing and Coding: Corneal Pachymetry

WPS-J8-L34760, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A57637, Billing and Coding: Visual Field Examination

FIRST_COAST-L33766, Visual Field Examination

NGS-JK-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

NGS-JK-L33630, Corneal Pachymetry

NGS-JK-L33574, Visual Fields Testing

`H40.1430`, Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

H40.1430, Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`H40.1430`, Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified