Does T86.8413 require prior authorization?

No, T86.8413 does not require prior authorization (high confidence). Covered without prior authorization.

`T86.8413`, Corneal transplant failure, bilateral

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
Corneal pachymetry (measurement of corneal thickness) is covered to evaluate patients with a diagnosis of increased intraocular pressure.
Repeat corneal pachymetry is covered after interval corneal trauma or corneal surgery to reassess corneal thickness.
Corneal pachymetry is generally covered when performed as indicated by current medical literature or accepted standards of practice for clinical management.
SCODI (CPT 92133, 92134) is considered medically reasonable and necessary for evaluation of retinal disorders, glaucoma, and anterior segment disorders as documented in LCD L34760.
Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when medically reasonable and necessary for management of retinal conditions undergoing active treatment, per LCD L35038.

CGS-J15-L33999, Corneal Pachymetry

J15

CGS-J15-L34008, Computerized Corneal Topography

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L33999, Corneal Pachymetry

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