Does H21.509 require prior authorization?

No, H21.509 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H21.509` — Unspecified adhesions of iris and ciliary body, unspecified eye

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When the service is performed in a hospital inpatient or outpatient setting, use modifier -26 to indicate the professional component.
Billing and coding must adhere to the coverage indications, limitations, and medical necessity criteria described in the associated LCD L34615 Visual Fields; follow that LCD for clinical eligibility and documentation requirements.
Prior to billing Medicare, verify applicable code combinations and correct coding guidelines with the CCI (Correct Coding Initiative).
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
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.

A57483 — Billing and Coding: Visual Fields

J05

L34615 — Visual Fields

J05

A57637 — Billing and Coding: Visual Field Examination

J09

L33766 — Visual Field Examination

J09

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