Does Q87.87 require prior authorization?

No, Q87.87 does not require prior authorization (high confidence). Covered without prior authorization.

`Q87.87`, Hao-Fountain Syndrome

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
This billing and coding guideline complements Local Coverage Determination (LCD) L34424 for Magnetic Resonance Angiography; refer to LCD L34424 for clinical indications, medical necessity criteria, and specific coding rules.
Claims must include the referring/ordering physician's name and NPI when required by the service, and all same-day services for the same beneficiary by the same provider must be billed on the same claim.

Fundus photography (CPT 92250, 92228) is covered when medical necessity is documented in the patient's medical record including relevant history, physical exam, results of pertinent tests, an interpretation/report, and retained copies of the photographs.
Extended ophthalmoscopy (CPT 92201, 92202) is covered when medical necessity is documented per-eye with a retinal drawing that meets the policy specifications, relevant history, physical exam, and test results recorded.
Professional (26) and/or technical (TC) components of fundus photography CPT 92250 and 92228 may be billed separately when only one component is performed, with the appropriate modifier reported.
When extended ophthalmoscopy is performed during a global surgical period and is unrelated to the surgery (same provider), bill the extended ophthalmoscopy with modifier 79 (and the appropriate site modifier if unilateral).
Fundus photography may be used to diagnose or document macular degeneration.
Fundus photography is covered to document abnormalities or disease processes of the retina when photographs and an interpretation/report are necessary for diagnosis, monitoring, or treatment planning.

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

J15

CGS-J18-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J18

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A56612, Billing and Coding: CT of the Head

A56775

Ask Backwork about documentation requirements, denial risks, or coverage in your state.