Does T37.3X4D require prior authorization?

No, T37.3X4D does not require prior authorization (high confidence). Covered without prior authorization.

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`T37.3X4D`, Poisoning by other antiprotozoal drugs, undetermined, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Document general ophthalmoscopy and biomicroscopy findings in the medical record even when these services are included in extended ophthalmoscopy and not separately billed.
For extended ophthalmoscopy, include a drawing or equivalent documentation that demonstrates the extended nature of the exam to support separate payment.
Orders for CPT 92227 and CPT 92228 must be from the treating physician or other treating practitioner acting within the scope of license and Medicare requirements and this order must be documented in the record.

Part B providers must indicate the actual number of tests (one unit per antigen/test) in Box 24G of Form CMS-1500 (paper) or in the service field on EMC claims; the number of tests must also be shown on the claim for MPFSDB payment.

Key Coverage Criteria

Extended ophthalmoscopy (CPT 92201, 92202) is payable when documented as an extended ophthalmoscopy that meets indicated standards (e.g., includes a retinal drawing or equivalent documentation) beyond a general ophthalmologic exam.
Fundus photography (CPT 92227, CPT 92228) is covered when ordered by the treating physician or other treating practitioner acting within the scope of his/her license and Medicare requirements.
CPT 92227 is covered when used to evaluate asymptomatic patients at risk with known disease likely to cause retinal disease (e.g., diabetes mellitus) when ordered by the treating physician.
CPT 92228 is a covered service when ordered by the treating physician or other treating practitioner acting within the scope of license and Medicare requirements.
Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.

4 Active Policies

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

WPS-J8-L36402, Allergy Testing

A53060, Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

`T37.3X4D`, Poisoning by other antiprotozoal drugs, undetermined, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

T37.3X4D, Poisoning by other antiprotozoal drugs, undetermined, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`T37.3X4D`, Poisoning by other antiprotozoal drugs, undetermined, subsequent encounter