Does H18.20 require prior authorization?

No, H18.20 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H18.20` — Unspecified corneal edema

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.
When both procedures are performed, append modifier 59 and provide clear medical record documentation explaining the clinical necessity and how the services are distinct.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
When distinct clinical circumstances require both SCODI (CPT 92133 or 92134) and fundus photography (CPT 92250) to evaluate or treat the patient, both procedures may be reported together with modifier 59 to indicate a distinct procedural service.
SCODI (CPT 92133, 92134) is considered medically reasonable and necessary for evaluation of retinal disorders, glaucoma, and anterior segment disorders as documented in LCD L34760.
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.

A57483 — Billing and Coding: Visual Fields

J05

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

L34615 — Visual Fields

J05

A56916 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

A56537

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