Does H44.519 require prior authorization?

No, H44.519 does not require prior authorization (high confidence). Covered without prior authorization.

`H44.519`, Absolute 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.
Primary congenital glaucoma (PCG) — viscocanalostomy/combined viscocanalostomy and trabeculotomy were studied in pediatric PCG (Qian 2017; Cochrane review includes trials comparing viscocanalostomy).
Use as a MIGS (minimally invasive glaucoma surgery) option for earlier-stage glaucoma where bleb-related complications are a concern — e.g., statement: "Canaloplasty will likely be used most often in earlier stages of glaucoma...may also be indicated in patients who may not need IOP-lowering to the degree that is achievable with trabeculectomy."
Procedures / devices discussed (clinical contexts in which they were studied): viscocanalostomy, phacoviscocanalostomy, canaloplasty (including iTrack/Glaucolight microcatheter approaches), canaloplasty with Stegmann Canal Expander, ab interno canaloplasty (ABiC), OMNI Surgical System (360° canaloplasty + 180° trabeculotomy), Visco360, iStent, Trabectome, GATT combined with ABiC.
Combined gonioscopy-assisted transluminal trabeculotomy (GATT) with Ab interno canaloplasty (ABiC) in conjunction with phacoemulsification for the treatment of patients with POAG
Use of the combined procedure to decrease intraocular pressure (IOP) and reduce the number of anti-glaucoma medications in POAG patients (as reported by the cited 12-month study)

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0435, Viscocanalostomy and Canaloplasty

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