Does H52.211 require prior authorization?

No, H52.211 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`H52.211`, Irregular astigmatism, right eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted the test.
The patient medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.

Key Coverage Criteria

Computerized corneal topography is billable when performed as a diagnostic test for corneal conditions and the claim includes a diagnosis code that best describes the patient's condition for which the service was performed.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: following cataract extraction.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: trauma to the eye which has damaged the lens.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: congenital cataract.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: congenital aphakia.
Standard monofocal intraocular lens (IOL) implant is considered medically necessary for any of the following conditions: lens subluxation/displacement.

6 Active Policies

CGS-J15-L34008, Computerized Corneal Topography

J15

CGS-J18-L34008, Computerized Corneal Topography

J18

AMBETTER-CP.VP.13, Preventative (Routine) Eye Examination

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

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H52.211, Irregular astigmatism, right eye