Does H40.53X4 require prior authorization?

No, H40.53X4 does not require prior authorization (high confidence). Covered without prior authorization.

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`H40.53X4`, Glaucoma secondary to other eye disorders, bilateral, indeterminate stage

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.
Claims for SCODI must be submitted to the Part B MAC; bill all same‑day services for the same beneficiary/provider on the same claim.

Key Coverage Criteria

Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
SCODI (CPT 92133, 92134) is considered medically reasonable and necessary for evaluation of retinal disorders, glaucoma, and anterior segment disorders as documented in LCD L34760.
Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).

20 Active Policies

CGS-J15-L33999, Corneal Pachymetry

J15

CGS-J15-L34394, Visual Fields Testing

J15

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

J15

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

J15

CGS-J15-L34393, Ocular Photography - External

J15

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

J15

CGS-J18-L34393, Ocular Photography - External

J18

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-L34394, Visual Fields Testing

J18

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

J18

WPS-J5-L34615, Visual Fields

A57483, Billing and Coding: Visual Fields

A55639, Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions

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

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

WPS-J5-L37205, Chemotherapy Drugs and their Adjuncts

NGS-J6-L33630, Corneal Pachymetry

NGS-J6-L33628, Panretinal (Scatter) Laser Photocoagulation

`H40.53X4`, Glaucoma secondary to other eye disorders, bilateral, indeterminate stage

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

H40.53X4, Glaucoma secondary to other eye disorders, bilateral, indeterminate stage

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`H40.53X4`, Glaucoma secondary to other eye disorders, bilateral, indeterminate stage