Does H53.40 require prior authorization?

No, H53.40 does not require prior authorization (high confidence). Covered without prior authorization.

`H53.40`, Unspecified visual field defects

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
SCODI (CPT 92133, 92134) is considered medically reasonable and necessary for evaluation of retinal disorders, glaucoma, and anterior segment disorders as documented in LCD L34760.
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
SCODI is medically reasonable and necessary for evaluating retinal disorders, including macular abnormalities and retinal thickness assessment.
SCODI is medically reasonable and necessary for diagnosing and managing glaucoma, including normal-tension glaucoma, by assessing the optic nerve head and retinal nerve fiber layer.
SCODI may be used for narrow angle, suspected narrow angle, and mixed narrow-and-open-angle glaucoma to evaluate anterior segment anatomy.

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J15

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L34399

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