Does M05.451 require prior authorization?

No, M05.451 does not require prior authorization (high confidence). Code is covered without prior authorization.

`M05.451`, Rheumatoid myopathy with rheumatoid arthritis of right hip

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Patient allergy history must document absence of iodine allergy prior to administration of ICG.
When a non-physician practitioner performs fluorescein or ICG angiography, documentation must reflect that a physician was present in the office and immediately available (direct supervision).
Medical record documentation must include evidence of medical necessity for each eye examined.
Physician must document in the medical record that definitive antifungal treatment options were reviewed and discussed with the patient at the initial visit before debridement of a mycotic nail is reimbursed.

Fluorescein angiography with interpretation is medically necessary as an adjunct to diagnosis of chorioretinal vascular abnormalities, especially choroidal neovascularization, noninfective vasculitis, and age-related macular degeneration (AMD).
Fluorescein angiography is appropriate to evaluate intraocular tumors, visual loss related to systemic disease, acute exudative inflammations such as toxoplasmosis, and optic disc edema.
Fluorescein angiography is useful in diabetic retinopathy to identify ischemia and neovascularization, locate microaneurysms, and define macular edema.
Fluorescein angiography following treatment (for example of CNV) is medically necessary to monitor for recurrence or to detect additional treatable or occult lesions, usually when there is a change in the clinical picture but may be performed without clinical change most often for CNV.
Indocyanine green (ICG) angiography may be a valuable diagnostic adjunct to fluorescein angiography for retinal neovascularization, choroidal neovascularization, serous detachment of the retinal pigment epithelium (RPE), hemorrhagic RPE detachment, and retinal hemorrhage.
ICG angiography is useful to visualize choroidal vessels through the RPE or when retinal or vitreous hemorrhage would otherwise obscure visualization, and to evaluate feeder vessels, late-phase choroidal leakage, and ruptures of the pigment epithelium.

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

J15

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