Does H59.021 require prior authorization?

No, H59.021 does not require prior authorization (high confidence). Covered without prior authorization.

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`H59.021`, Cataract (lens) fragments in eye following cataract surgery, right eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Document general ophthalmoscopy and biomicroscopy findings in the medical record even when these services are included in extended ophthalmoscopy and not separately billed.
For extended ophthalmoscopy, include a drawing or equivalent documentation that demonstrates the extended nature of the exam to support separate payment.
Orders for CPT 92227 and CPT 92228 must be from the treating physician or other treating practitioner acting within the scope of license and Medicare requirements and this order must be documented in the record.

Key Coverage Criteria

Extended ophthalmoscopy (CPT 92201, 92202) is payable when documented as an extended ophthalmoscopy that meets indicated standards (e.g., includes a retinal drawing or equivalent documentation) beyond a general ophthalmologic exam.
Fundus photography (CPT 92227, CPT 92228) is covered when ordered by the treating physician or other treating practitioner acting within the scope of his/her license and Medicare requirements.
CPT 92227 is covered when used to evaluate asymptomatic patients at risk with known disease likely to cause retinal disease (e.g., diabetes mellitus) when ordered by the treating physician.
CPT 92228 is a covered service when ordered by the treating physician or other treating practitioner acting within the scope of license and Medicare requirements.
Cataract extraction is covered when necessary to provide an unimpeded view of the fundus to allow proper management of posterior segment disease, with the cataract diagnosis billed as primary and the posterior segment disease as secondary.
Cataract extraction is covered for anisometropia when there is significant aniseikonia secondary to a prior cataract extraction with IOL implant and the aniseikonia is visually significant to the patient.

20 Active Policies

CGS-J15-L33954, Cataract Extraction

J15

CGS-J15-L37578, Micro-Invasive Glaucoma Surgery (MIGS)

J15

CGS-J18-L37578, Micro-Invasive Glaucoma Surgery (MIGS)

J18

CGS-J18-L33954, Cataract Extraction

J18

WPS-J5-L39905, Cataract Surgery

A59805, Billing and Coding: Cataract Surgery

NGS-J6-L33558, Cataract Extraction

A56544, Billing and Coding: Cataract Extraction

WPS-J8-L39905, Cataract Surgery

FIRST_COAST-L38926, Cataract Extraction (including Complex Cataract Surgery)

A58592, Billing and Coding: Cataract Extraction (including Complex Cataract Surgery)

NOVITAS-JH-L35091, Cataract Extraction (including Complex Cataract Surgery)

NGS-JK-L33558, Cataract Extraction

NOVITAS-JL-L35091, Cataract Extraction (including Complex Cataract Surgery)

A56615, Billing and Coding: Cataract Extraction (including Complex Cataract Surgery)

A56613, Billing and Coding: Cataract Surgery

AMBETTER-CP.VP.26, Extended Ophthalmoscopy

A57195, Billing and Coding: Cataract Surgery in Adults

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

A53060, Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

`H59.021`, Cataract (lens) fragments in eye following cataract surgery, right eye

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

H59.021, Cataract (lens) fragments in eye following cataract surgery, right eye

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`H59.021`, Cataract (lens) fragments in eye following cataract surgery, right eye