Does H10.10 require prior authorization?

No, H10.10 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H10.10` — Acute atopic conjunctivitis, unspecified eye

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must specify the number of doses prepared for CPT 95165 (number of doses must be documented on the claim).
Medical records must document that an MD/DO prepared the antigens, examined the patient, and determined the plan of treatment and dosage regimen (including prior skin test results and personal history used for concentration/volume calculations).
Document vial volumes and how many 1 cc aliquots (or equivalent) are available from each multidose vial to support the billed dose count.
Append modifier EJ on maintenance immunotherapy claims and document that the service is maintenance in the medical record.

CPT 95165 may be billed for professional preparation and provision of non-venom allergen antigen extracts (specify number of doses) when the physician prepares the antigen and determines the dosage regimen.
Payment may be made for a reasonable supply of antigens prepared for a particular patient only if the preparing physician is an MD or DO who has examined the patient and determined a plan of treatment and dosage regimen.
Antigens must be administered according to the physician's plan and may be given by an MD/DO or a properly instructed person under physician supervision.
If medically necessary, the physician may prepare and bill for more than one multidose vial for a patient.
CPT 95165 covers physician preparation and provision of non-venom allergen antigen extracts (includes calculations for concentration and volume) but does not include administration of the antigen.
Payment may be made for antigens prepared for a particular patient when the antigens are prepared by a Doctor of Medicine (MD) or Doctor of Osteopathy (DO) who has examined the patient and determined a treatment plan and dosage regimen.

L40195 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J05

A60275 — Billing and Coding: Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J05

A60276 — Billing and Coding: Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J05

L36408 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J05

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