Does H52.203 require prior authorization?

No, H52.203 does not require prior authorization (high confidence). Covered without prior authorization.

`H52.203`, Unspecified astigmatism, bilateral

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation that the patient has received refractive hardware must be maintained.
Acceptable delivery methods to document receipt: member or authorized representative picks up at optical shop; delivery by mail or delivery service; delivery to a nursing facility on behalf of the member.
Use the delivery date as the date of service on the claim (date beneficiary or authorized representative picks up the refractive hardware, or date shipped if mailed).
Reference the member's plan specifics to determine coverage, frequency, and applicable codes for frames and lenses.

Coverage and frequency of frames and lenses are determined by the member's plan specifics and apply as stated in the member's plan.
Lens add-ons may be covered when permitted by the member's specific reference plan benefits and medical necessity determinations.
Fitting of spectacles including measurement of anatomical facial characteristics, writing of laboratory specifications, and final adjustment of spectacles to the visual axis and anatomical topography.
Dispensing a complete set of glasses (frame and two lenses) with associated fitting services as part of a preventive (routine) eye examination.
Coverage for contact lenses is determined by the member's specific plan; refer to the member's plan specifics for coverage applicability.
Hypermetropia (farsightedness) — unspecified, right, left, or bilateral (H52.00–H52.03).

AMBETTER-CP.VP.13-Attachment-A-Refractive-Hardware, Preventive (Routine) Eye Examination Attachment A: Refractive Hardware

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