Does H53.009 require prior authorization?

No, H53.009 does not require prior authorization (high confidence). Covered without prior authorization.

`H53.009`, Unspecified amblyopia, 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.
An initial 12-month trial of dichoptic digital therapy is consideredmedically necessarywhen the following criteria are met:
Individual is age 4 through 13 years (at least 4 years 0 days and less than 14 years old);and
The individual has anisometropic, small-angle (10 prism diopters or less) strabismic amblyopia or mixed-mechanism amblyopia;and
There is failure to respond to a 6-month trial of patching or atropine (or contraindication/allergy/intolerance to atropine);and
For CureSight and RevitalVision, the individual has passed a dedicated 10 minute in-clinic performance ability test to assure suitable eye tracking performance (validity of eye tracking data > 90% and successful calibration process);and

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

ANTHEM-CG-MED-102, Dichoptic Digital Therapy for Amblyopia

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