B30.0 — Keratoconjunctivitis due to adenovirus
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The medical record must document the ordering provider's assessment related to the patient's complaint prompting external ocular photography, including relevant medical history and physical exam findings supporting medical necessity.
- All external ocular photographs must be permanently labeled with the patient's name, date, and notation of which eye is pictured, and copies must be available for Medicare review.
- An interpretation and report specific to the photograph(s), including comparison to prior photographs when available, must be maintained in the medical record and available to the contractor upon request.
- If additional photographs are taken to track changes, written documentation describing those changes must be maintained in the patient's medical record.
Key Coverage Criteria
- External ocular photography is covered when ordered by an authorized/referring provider to document, diagnose, or monitor an ocular condition and when medical record documentation supports medical necessity.
- External ocular photographs are covered to track changes in a patient's ocular condition provided changes are documented in writing and compared to prior photographs when available.
- Technical (TC) and professional (26) components of external ocular photography are payable under Part B when billed with the appropriate modifier and performed in allowable places of service as specified by Medicare.
- External ocular photography is covered when photo-documentation is required to track progression or lack of progression of an eye condition or to document response or progression related to a course of treatment.
- External ocular photography is covered when a special camera is used to obtain magnified medical-quality photographs of lesions (e.g., cornea, iris, eyelids) for the purpose of following the patient's condition.
- Retisert (fluocinolone acetonide intravitreal 0.59 mg implant) and Yutiq (fluocinolone acetonide intravitreal 0.18 mg implant) for the treatment of chronic non-infectious uveitis (including birdshot chorioretinopathy) affecting the posterior segment of the eye in persons who do not respond to or are intolerant to conventional treatment (i.e., failed corticosteroid or immunosuppressive therapy);
4 Active Policies
AMBETTER-CP.VP.43 — External Ocular Photography
AETNA-CPB-0719 — Fluocinolone Acetonide Intra-vitreal Implant (Retisert, Yutiq and Iluvien)
A57068 — Billing and Coding: Ocular Photography - External
L34393 — Ocular Photography - External
Related Codes
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