Does H49.819 require prior authorization?

No, H49.819 does not require prior authorization (high confidence). Covered without prior authorization.

`H49.819`, Kearns-Sayre syndrome, 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.
Aetna considers home uterine activity monitoring (HUAM) experimental and investigational.
In its discretion, Aetna may consider HUAM medically necessary upon review of each circumstance and consideration of any of the following criteria:
Women with complicated pregnancies who cannot feel their contractions. HUAM may be considered medically necessary on an individual case exception basis for pregnant women with gestational age greater than 18 weeks who cannot feel their contractions and have any of the following complications:
Incompetent cervix (as documented by need for cerclage or signs of cervical incompetence (funneling on valsalva, silent shortening))
Presence of risk factors that increase risk of preterm birth: placenta previa with hemorrhage; history of classical caesarean section or deep myomectomy with contractions/cervical change in index pregnancy, such that woman is not able to safely tolerate contractions

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

AETNA-CPB-0127, Home Uterine Activity Monitoring

AETNA-CPB-0202, Magnetic Resonance Spectroscopy (MRS)

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