Does H40.1494 require prior authorization?

No, H40.1494 does not require prior authorization (high confidence). Covered without prior authorization.

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`H40.1494`, Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, indeterminate stage

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Document general ophthalmoscopy and biomicroscopy findings in the medical record even when these services are included in extended ophthalmoscopy and not separately billed.
For extended ophthalmoscopy, include a drawing or equivalent documentation that demonstrates the extended nature of the exam to support separate payment.
Orders for CPT 92227 and CPT 92228 must be from the treating physician or other treating practitioner acting within the scope of license and Medicare requirements and this order must be documented in the record.

When extended ophthalmoscopy is performed during a global surgery period and is unrelated to the surgical condition, document the unrelatedness and report modifier -76 or -79 as appropriate.

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Every page of the record must be legible and include appropriate patient identification information such as complete name and dates of service.

Key Coverage Criteria

Extended ophthalmoscopy (CPT 92201, 92202) is payable when documented as an extended ophthalmoscopy that meets indicated standards (e.g., includes a retinal drawing or equivalent documentation) beyond a general ophthalmologic exam.
Fundus photography (CPT 92227, CPT 92228) is covered when ordered by the treating physician or other treating practitioner acting within the scope of his/her license and Medicare requirements.
CPT 92227 is covered when used to evaluate asymptomatic patients at risk with known disease likely to cause retinal disease (e.g., diabetes mellitus) when ordered by the treating physician.
CPT 92228 is a covered service when ordered by the treating physician or other treating practitioner acting within the scope of license and Medicare requirements.
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Fuchs' endothelial dystrophy

5 Active Policies

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0435, Viscocanalostomy and Canaloplasty

AETNA-CPB-0681, Corneal Pachymetry

A53060, Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

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H40.1494, Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, indeterminate stage