Does H59.039 require prior authorization?

No, H59.039 does not require prior authorization (high confidence). Covered without prior authorization.

`H59.039`, Cystoid macular edema following cataract surgery, unspecified eye

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For clinical use as presented in the literature, documentation should include the imaging modality and device used, numerical values for the measured parameter(s) (e.g., ONSD in mm, RNFL/GCIPL thickness in µm, OCTA vessel density %), measurement technique and timing (e.g., relation to ROSC or symptom onset), and image quality metrics or notes on artifacts.
Accepted optic nerve and retinal imaging methods include the following: Confocal laser scanning ophthalmoscopy; Nerve fiber layer testing or analysis (confocal laser scanning tomography with polarimetry); Optical coherence tomography (OCT); Stereophotogrammetry.
In addition to annual screening that should begin after 5 years of use (or sooner if there are unusual risk factors), a baseline study of optic nerve and retinal imaging is considered medically necessary before initiation of chloroquine, hydroxychloroquine, or vigabatrin therapy.

AETNA-CPB-0344, Optic Nerve and Retinal Imaging Methods

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