Does H43.829 require prior authorization?

No, H43.829 does not require prior authorization (high confidence). Covered without prior authorization.

`H43.829`, Vitreomacular adhesion, 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 clinical use as presented in the literature, documentation should include the imaging modality and device used, numerical values for the measured parameter(s) (e.g., ONSD in mm, RNFL/GCIPL thickness in µm, OCTA vessel density %), measurement technique and timing (e.g., relation to ROSC or symptom onset), and image quality metrics or notes on artifacts.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
Age-related macular degeneration
Pseudotumor cerebri
B58.01 Toxoplasma chorioretinitis
C69.20 - C69.32 Malignant neoplasm of the retina and choroid
D18.09 Hemangioma of other sites [retina]

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-0344, Optic Nerve and Retinal Imaging Methods

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