Does P07.37 require prior authorization?

No, P07.37 does not require prior authorization (high confidence). Covered without prior authorization.

`P07.37`, Preterm newborn, gestational age 34 completed weeks

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Detailed drawing(s) of views of the patient's retina(s) and any defects documented in the medical record.
Record of the examination method used (direct vs indirect; contact lens, H‑ruby lens, or 90‑diopter lens), which eye(s) were examined, and identity/licensure of the performing eye care provider.
Detailed retinal drawing (disc, macula or periphery) accompanied by an interpretation and report.
Drawing must be anatomically specific to the patient, clearly labeled, and of sufficient size (no less than 3–4 inches in diameter).

Therapeutic use of iNO is consideredmedically necessarywhen either criterion AorB is met:
Inhaled nitric oxide is consideredmedically necessaryas a component of the treatment of hypoxic respiratory failure (see definition) in neonates when the following criteria are met:The neonate was born at 34 or more weeks of gestation;andConventional therapies have failed;andNeonate does not have a congenital diaphragmatic hernia;or
The neonate was born at 34 or more weeks of gestation;and
Conventional therapies have failed;and
Neonate does not have a congenital diaphragmatic hernia;or
Inhaled nitric oxide is consideredmedically necessaryin the perioperative management of congenital heart disease when all the following criteria (1, 2 and 3) are met:The treated individual is an infant age 1 year (365 days) or less;andThere is preserved left ventricular function;andAdministered ineitherof the following clinical scenarios (a or b):As a prophylactic therapy when all the criteria (i, ii,andiii) are met;andInitiated ateitherof the following times:During surgical repair;orImmediately [...]

ANTHEM-CG-MED-69, Inhaled Nitric Oxide

AMBETTER-CP.VP.26, Extended Ophthalmoscopy

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