H02.049 — Spastic entropion of unspecified eye, unspecified eyelid
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing/coding guidelines that complement the Local Coverage Determination (LCD) L33458 for chemodenervation; follow LCD L33458 for specific coverage criteria and coding guidance.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information such as complete name and dates of service.
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
Key Coverage Criteria
- Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
- Chemodenervation of muscles innervated by the facial nerve for management of blepharospasm or hemifacial spasm.
- Chemodenervation of cervical spinal muscles for management of spasmodic torticollis (cervical dystonia).
- Chemodenervation of extremity muscles for management of dystonias, cerebral palsy, upper and lower limb spasticity, and multiple sclerosis–related spasticity.
- Chemodenervation of extraocular muscles for the management of strabismus.
- Chemodenervation of the lower esophageal sphincter for treatment of achalasia.
4 Active Policies
A57637 — Billing and Coding: Visual Field Examination
J09
L33766 — Visual Field Examination
J09
A56646 — Billing and Coding: Chemodenervation
L33458 — Chemodenervation
Related Codes
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