Does H40.159 require prior authorization?

No, H40.159 does not require prior authorization (high confidence). Covered without prior authorization.

`H40.159`, Residual stage of open-angle glaucoma, unspecified eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Laser trabeculoplasty is consideredmedically necessaryfor glaucoma in the following situations:
As initial treatment of newly diagnosed glaucoma;or
As treatment for medically refractory glaucoma;or
As treatment for individuals who are at high risk for nonadherence to medical therapy (for example, those who cannot tolerate medications or who are noncompliant with medications due to memory problems or have difficulty with instillation).
Laser peripheral iridotomy is consideredmedically necessaryin the following situations:

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

ANTHEM-CG-SURG-100, Laser Trabeculoplasty and Laser Peripheral Iridotomy

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

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