Does H46.9 require prior authorization?

No, H46.9 does not require prior authorization (high confidence). Covered without prior authorization.

`H46.9`, Unspecified optic neuritis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

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.
SCODI is medically reasonable and necessary for evaluating retinal disorders, including macular abnormalities and retinal thickness assessment.
SCODI is medically reasonable and necessary for diagnosing and managing glaucoma, including normal-tension glaucoma, by assessing the optic nerve head and retinal nerve fiber layer.
SCODI may be used for narrow angle, suspected narrow angle, and mixed narrow-and-open-angle glaucoma to evaluate anterior segment anatomy.
SCODI may be used to determine proper intraocular lens power for patients with prior refractive surgery who require cataract extraction, when documentation of the prior refractive procedure is in the record.
SCODI may be used for evaluation of iris tumor.

CGS-J15-L38992, Electroretinography (ERG)

J15

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

J15

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

J15

CGS-J15-L34394, Visual Fields Testing

J15

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