Does H47.10 require prior authorization?

No, H47.10 does not require prior authorization (high confidence). Covered without prior authorization.

`H47.10`, Unspecified papilledema

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.
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.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
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 evaluation and monitoring of glaucoma when clinical data (optic nerve, retinal nerve fiber layer, anterior chamber, and visual field) are being used to diagnose or follow glaucoma.
SCODI may be used to follow glaucoma suspects or patients with mild glaucomatous damage who have visual field findings such as no detectable defect, mild generalized reduction in retinal sensitivity, mild constriction of isopters, nasal step peripheral to 20 degrees, or small relative Bjerrum area defects peripheral to 9 degrees.
SCODI may be used in glaucoma suspects or mild damage when optic nerve findings include symmetric or vertically elongated cup enlargement, intact neural rim with rim:disc ratio >0.2, focal notching, absence of definite pathologic cupping, or previously observed disc hemorrhage.
SCODI may be appropriate in patients with moderate glaucomatous damage to monitor progression, especially when alternating SCODI and visual field testing over time increases sensitivity to detect change.

CGS-J15-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J15

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

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L38992, Electroretinography (ERG)

J15

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