Does B39.4 require prior authorization?

No, B39.4 does not require prior authorization (high confidence). Code is covered without prior authorization.

`B39.4` — Histoplasmosis capsulati, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Explicit clinical documentation is required to justify any treatment frequency that is more frequent than approximately every 4 weeks in a given eye.
For Part B claims, enter 'Intravitreal bevacizumab, [dose] mg' in Item 19 of the CMS-1500 or in Loop 2300/2400 NTE01 (NTE, 02) for electronic claims.
When billing J7999, enter '1' in the days/units field for one eye or '2' if both eyes are treated in the same encounter.
When billing CPT 67028, use modifier RT or LT to indicate the eye treated; if billing bilateral use modifier 50.

When intravitreal bevacizumab is acquired from a compounding source or compounded in the physician's facility/office, bill using HCPCS J7999 on claims.
HCPCS J7999 shall be used for all compounded injectable drugs (not restricted to bevacizumab).
For Part A claims for intravitreal compounded bevacizumab, bill using HCPCS C9257 and provide the number of units.
Use scanning computerized ophthalmic diagnostic imaging (CPT 92134) at 4–6 week intervals when appropriate to evaluate need for re-treatment.
For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

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

J05

L34658 — Vitamin D Assay Testing

J05

A57484 — Billing and Coding: Vitamin D Assay Testing

J05

L34380

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