Does H40.60X4 require prior authorization?

No, H40.60X4 does not require prior authorization (high confidence). Covered without prior authorization.

ICD-10-CM H40.60X4, Glaucoma secondary to drugs, unspecified eye, indeterminate stage | No Prior Auth

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`H40.60X4`, Glaucoma secondary to drugs, 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.

The medical record must include the ordering provider's assessment relevant to the patient's complaint for that visit.

The medical record must include relevant medical history related to the 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.
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).

9 Active Policies

CGS-J15-L33999, Corneal Pachymetry

J15

CGS-J18-L33999, Corneal Pachymetry

J18

A57483, Billing and Coding: Visual Fields

WPS-J5-L34615, Visual Fields

WPS-J8-L34615, Visual Fields

A57637, Billing and Coding: Visual Field Examination

FIRST_COAST-L33766, Visual Field Examination

A56457, Billing and Coding: Corneal Pachymetry

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

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H40.60X4, Glaucoma secondary to drugs, unspecified eye, indeterminate stage