Does S04.012S require prior authorization?

No, S04.012S does not require prior authorization (high confidence). Covered without prior authorization.

`S04.012S`, Injury of optic nerve, left eye, sequela

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Use full-field ERG to diagnose loss of retinal function or distinguish retinal lesions from optic nerve lesions.
Use VEP/VER to evaluate ischemic optic neuropathy.
Use VEP/VER to evaluate toxic amblyopias.

A57599, Billing and Coding: Visual Electrophysiology Testing

WPS-J5-L37015, Visual Electrophysiology Testing

A57060, Billing and Coding: Visual Electrophysiology Testing

A56551, Billing and Coding: Visual Fields Testing

NGS-J6-L36831

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