Does H43.819 require prior authorization?

No, H43.819 does not require prior authorization (high confidence). Covered without prior authorization.

`H43.819`, Vitreous degeneration, unspecified eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
For Er:YAG laser for diffuse actinic cheilitis: biopsy results demonstrating no evidence of high-grade dysplasia or cancer.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
Laser adjuncts / debridement for peri-implantitis and periodontal conditions
Er:YAG laser use for reductions in post-op pain/edema (e.g., third molar removal) and other oral/jaw conditions
Physical and laser therapies for genitourinary syndrome of menopause / vulvovaginal atrophy
Laser approaches to prevent posterior capsule opacification
Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women

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

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

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

AETNA-CPB-0354, YAG Laser in Ophthalmology and Other Selected Indications

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