Does H47.231 require prior authorization?

No, H47.231 does not require prior authorization (high confidence). Covered without prior authorization.

`H47.231`, Glaucomatous optic atrophy, right eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Medical record documentation by the ordering/referring physician must state the clinical indication/medical necessity for the test and include the test results.
If the performing provider is different from the ordering/referring physician, the performing provider must maintain hard copy test results and interpretation plus copies of the ordering/referring physician's order.
Documentation should contain a history and physical (H&P) supporting the diagnosis for which the corneal pachymetry is being rendered.

Corneal pachymetry (measurement of corneal thickness) is covered to evaluate patients with a diagnosis of increased intraocular pressure.
Repeat corneal pachymetry is covered after interval corneal trauma or corneal surgery to reassess corneal thickness.
Corneal pachymetry is generally covered when performed as indicated by current medical literature or accepted standards of practice for clinical management.
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.
Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L38992, Electroretinography (ERG)

J15

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

J15

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

J15

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