Does E08.37X9 require prior authorization?

No, E08.37X9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E08.37X9` — Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

CGM devices billed as HCPCS E2103 (and E2102 effective July 1, 2022) must have PDAC coding verification and be listed on the PDAC Product Classification List (PCL) for the respective HCPCS code prior to billing.
For items subject to Final Rule 1713, a face-to-face encounter and a Written Order Prior to Delivery (WOPD) are required for specified HCPCS codes; claims without these will be denied as not reasonable and necessary and items delivered prior to receipt of a WOPD are ineligible for payment.
If beneficiary utilization of BGM testing supplies exceeds usual amounts, the medical record must document an in-person or Medicare-approved telehealth visit evaluating diabetes control, that ordered quantities are reasonable and necessary, and that beneficiary testing frequency corroborates dispensed quantities (narrative or testing log).

Medicare may classify adjunctive CGMs as DME (since Feb 28, 2022) when LCD and statutory requirements are met.
Home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs) are covered under the Durable Medical Equipment (DME) benefit when the device and use meet the related LCD reasonable-and-necessary requirements and other Medicare statutory/regulatory requirements.
Therapeutic (non-adjunctive) CGM devices that permit treatment decisions without confirmatory BGM are covered under DME.
A CGM system supply allowance (HCPCS A4238 or A4239) is covered when the beneficiary uses a stand-alone durable CGM receiver or an insulin infusion pump classified as DME to display glucose data, or when a non-DME device is used in conjunction with a durable CGM receiver.
For non-adjunctive CGM systems, the supply allowance (A4239) may include a home BGM and related supplies if clinically necessary.
Beneficiary has diabetes mellitus documented in the medical record.

A56232 — Billing and Coding: Foot Care

J05

A57637 — Billing and Coding: Visual Field Examination

J09

L33766 — Visual Field Examination

J09

A52464 — Glucose Monitor - Policy Article

J19

A52501 — Therapeutic Shoes for Persons with Diabetes - Policy Article

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