Does S04.019D require prior authorization?

No, S04.019D does not require prior authorization (high confidence). Covered without prior authorization.

`S04.019D`, Injury of optic nerve, unspecified eye, subsequent encounter

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.

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
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.
Use VEP/VER to evaluate nutritional amblyopias.
Use VEP/VER to evaluate optic nerve injury or optic nerve atrophy.

A57599, Billing and Coding: Visual Electrophysiology Testing

WPS-J5-L37015, Visual Electrophysiology Testing

A56551, Billing and Coding: Visual Fields Testing

NGS-J6-L36831, Visual Electrophysiology Testing

A57060

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