Does H26.40 require prior authorization?

No, H26.40 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H26.40` — Unspecified secondary cataract

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical record must include the ordering provider's assessment related to the patient's complaint for that visit, relevant medical history, and results of pertinent diagnostic tests or procedures.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.
When an ABN is used, Form CMS-R-131 should be signed by the beneficiary; for claims submitted to the Part A MAC, occurrence code 32 and the ABN date are required.
Claims for capsulotomy within three months of cataract surgery must include clear documentation justifying the need for the procedure (e.g., significant visual debility or listed risk factors).

Posterior capsular opacification (ACO/PCO) after cataract surgery causing significant visual debility is an indication for capsulotomy (YAG laser or discission).
Capsulotomy performed less than 3 months after cataract surgery is covered only when documented indications exist (examples: preoperative uveitis, chronic glaucoma, diabetes mellitus, prolonged pilocarpine use, or significant visual debility).
Repeat capsulotomy on the same eye (during the same or separate episode of care) is covered if the medical record contains a clear rationale and documented indications for the repeat procedure.
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.
Visual field examination is covered for patients with a documented diagnosis of glaucoma.

A57637 — Billing and Coding: Visual Field Examination

J09

L33766 — Visual Field Examination

J09

ANTHEM-CG-SURG-114 — CG-SURG-114 Ophthalmic use of Nd:YAG Laser for Posterior Capsulotomy

A56493 — Billing and Coding: Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy

A56613 — Billing and Coding: Cataract Surgery

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