Does T85.29XA require prior authorization?

No, T85.29XA does not require prior authorization (high confidence). Covered without prior authorization.

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`T85.29XA`, Other mechanical complication of intraocular lens, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

The medical record must document relevant medical history, physical examination, indications for testing, an order for testing, test results, and the IOL power calculation; records must include patient name and date of service and be available to Medicare on request.

Key Coverage Criteria

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.
Use diagnostic ultrasound A-scan (76519) for routine/simple cataract cases when performing IOL power calculation.
Use ultrasound B-scan (as clinically indicated) for patients with dense cataract where A-scan is not adequate for IOL power calculation.
Additional biometric testing beyond one scan is covered when there is an additional diagnosis beyond cataract and the medical need for the additional tests is fully documented.
Coverage for YAG capsulotomy follows the Local Coverage Determination L37644; see LCD L37644 for specific clinical indications.

20 Active Policies

CGS-J15-L33946, Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy

J15

CGS-J15-L34181, Ophthalmic Biometry for Intraocular Lens Power Calculation

J15

CGS-J15-L33944, Blepharoplasty

J15

CGS-J18-L33946, Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy

J18

CGS-J18-L34181, Ophthalmic Biometry for Intraocular Lens Power Calculation

J18

CGS-J18-L33944, Blepharoplasty

J18

WPS-J5-L34760, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A56916, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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

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

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

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

WPS-J8-L34760, 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

A56792, Billing and Coding: YAG Capsulotomy

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

A57070, Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation

ANTHEM-CG-SURG-72, Endothelial Keratoplasty

ANTHEM-CG-SURG-114, Ophthalmic use of Nd:YAG Laser for Posterior Capsulotomy

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T85.29XA, Other mechanical complication of intraocular lens, initial encounter