Does T85.21XD require prior authorization?

No, T85.21XD does not require prior authorization (high confidence). Covered without prior authorization.

`T85.21XD`, Breakdown (mechanical) of intraocular lens, subsequent encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

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.
Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
Ophthalmic biometry (CPT 76519 or 92136) is covered for preoperative intraocular lens (IOL) power calculation for patients undergoing cataract surgery.

A56537, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A56549, Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation

NGS-J6-L33621, Ophthalmic Biometry for Intraocular Lens Power Calculation

NGS-J6-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

NGS-JK-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

NGS-JK-L33621, Ophthalmic Biometry for Intraocular Lens Power Calculation

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

AMBETTER-CP.VP.06, Medically Necessary Optical Hardware

AMBETTER-CP.VP.14, Scanning Computerized Opthalmic Diagnostic Imaging

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