Does H47.019 require prior authorization?

No, H47.019 does not require prior authorization (high confidence). Covered without prior authorization.

`H47.019`, Ischemic optic neuropathy, 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.
None specified. This Clinical Policy Bulletin addresses obsolete and unreliable tests and procedures and lists tests/procedures that Aetna considers experimental and investigational (i.e., not covered).
CPT code 67570 (Optic nerve decompression [e.g., incision or fenestration of optic nerve sheath]) — covered if selection criteria are met
Papilledema accompanying pseudotumor cerebri (idiopathic intracranial hypertension) — optic nerve decompression surgery (e.g., optic nerve sheath fenestration) is considered medically necessary.
Progressive visual loss associated with craniofacial fibrous dysplasia — optic nerve decompression surgery is considered medically necessary.
Secondary intracranial hypertension with cerebrovenous sinus thrombosis — optic nerve decompression surgery is considered medically necessary.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0321, Behavioral Vision Therapy and Vision Restoration Therapy

AETNA-CPB-0415, Optic Nerve Decompression Surgery

AETNA-CPB-0438, Obsolete and Unreliable Tests and Procedures

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