Does A52.73 require prior authorization?

No, A52.73 does not require prior authorization (high confidence). Code is covered without prior authorization.

`A52.73` — Symptomatic late syphilis of other respiratory organs

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

Visual field testing is covered when billed to the Part A or Part B MAC with a valid ICD-10-CM diagnosis code that best describes the patient’s condition and when the service is reasonable and necessary.
For diagnostic visual field tests, report the test result on the claim if known; if the result is not known, report the signs or symptoms that prompted the test.
If the service requires a referring/ordering physician, include the ordering/referring physician’s name and NPI on the claim.
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Formal visual field testing is medically necessary for patients with a disorder of the eyelid(s) that may affect the visual field.
Formal visual field testing is medically necessary when a visual field defect is detected on gross (confrontation) visual field testing.

L33574 — Visual Fields Testing

J06

A56551 — Billing and Coding: Visual Fields Testing

J06

A57637 — Billing and Coding: Visual Field Examination

J09

L33766 — Visual Field Examination

J09

L34394 — Visual Fields Testing

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