Does H05.242 require prior authorization?

No, H05.242 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H05.242` — Constant exophthalmos, left eye

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
Billing and coding guidance in this article applies when immune globulin use meets the reasonable and necessary coverage criteria established in LCD L35093.
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis
H44.532 | Leucocoria, left eye

L34615 — Visual Fields

J05

A57483 — Billing and Coding: Visual Fields

J05

A56551 — Billing and Coding: Visual Fields Testing

J06

L33574 — Visual Fields Testing

J06

L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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