Does H52.213 require prior authorization?

No, H52.213 does not require prior authorization (high confidence). Covered without prior authorization.

`H52.213`, Irregular astigmatism, bilateral

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

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.
Routine preventive ophthalmic evaluation to detect common and serious ocular abnormalities.
Periodic re-examination of all patients, with emphasis on those who have risk factors for ocular disease, to prevent or minimize vision loss through early detection and treatment.
Preventive (routine) eye examinations to evaluate the visual system and related ocular structures.
Periodic re‑examination after an initial comprehensive exam that is normal or only shows refractive (optical) abnormalities to detect new or asymptomatic ocular disease (examples: glaucoma, diabetic retinopathy, age‑related macular degeneration).
Comprehensive evaluations for patients with no risk factors at routine intervals (frequencies specified elsewhere in the policy).

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

A56816

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