Does H53.019 require prior authorization?

No, H53.019 does not require prior authorization (high confidence). Covered without prior authorization.

`H53.019`, Deprivation 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.
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.

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

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.