Does A52.71 require prior authorization?

No, A52.71 does not require prior authorization (high confidence). Code is covered without prior authorization.

`A52.71` — Late syphilitic oculopathy

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When the service is performed in a hospital inpatient or outpatient setting, use modifier -26 to indicate the professional component.
Billing and coding must adhere to the coverage indications, limitations, and medical necessity criteria described in the associated LCD L34615 Visual Fields; follow that LCD for clinical eligibility and documentation requirements.
Prior to billing Medicare, verify applicable code combinations and correct coding guidelines with the CCI (Correct Coding Initiative).
Documentation should record the affected eye(s) because visual field testing is performed and billed separately for each eye.

Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
Visual field testing is medically necessary when a pale or swollen optic nerve is documented on recent examination.
Visual field testing is medically necessary for a documented diagnosis of glaucoma to monitor stabilization or progression of disease.

A57483 — Billing and Coding: Visual Fields

J05

L34615 — Visual Fields

J05

AETNA-CPB-0719 — Fluocinolone Acetonide Intra-vitreal Implant (Retisert, Yutiq and Iluvien)

ANTHEM-CG-MED-47 — CG-MED-47 Fundus Photography

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