Does H47.299 require prior authorization?

No, H47.299 does not require prior authorization (high confidence). Covered without prior authorization.

`H47.299`, Other optic atrophy, 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.
Initial optical coherence tomography of the posterior segment of the eye is consideredmedically necessaryfor any of the following:
To establish a diagnosis of a condition affecting the optic nerve or retina (including, but not limited to glaucoma, optic neuropathy, macular degeneration, diabetic retinopathy, macular edema, atrophy associated with degenerative retinal diseases),when a clinical diagnosis is uncertain;or
To establish a baseline prior to treatment of a condition affecting the optic nerve or retina.
Repeat optical coherence tomography of the posterior segment of the eye is consideredmedically necessaryto monitor a condition affecting the optic nerve or retina when there is documentation that changes detected on imaging (based on the anticipated clinical progression of the underlying disease) are likely to impact management; for example:
To monitor for disease progression in individuals with glaucoma;or

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

ANTHEM-CG-MED-85, Posterior Segment Optical Coherence Tomography

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