Does H01.111 require prior authorization?

No, H01.111 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H01.111` — Allergic dermatitis of right upper eyelid

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.

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.
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Visual field examination is covered for patients with inflammation or disorders of the eyelids that may affect the visual field.
Visual field examination is covered for patients with a documented diagnosis of glaucoma.

A57637 — Billing and Coding: Visual Field Examination

J09

L33766 — Visual Field Examination

J09

AMBETTER-CP.VP.43 — External Ocular Photography

A57068 — Billing and Coding: Ocular Photography - External

L34393 — Ocular Photography - External

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