Does H26.413 require prior authorization?

No, H26.413 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H26.413` — Soemmering's ring, bilateral

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.
Cataract extraction is covered when the physician performing the preoperative ophthalmologic evaluation lists cataract as the primary diagnosis (ICD-10-CM codes per LCD L35091).
Preoperative evaluation and management (E/M) services are covered when the evaluating clinician documents cataract as the primary or secondary diagnosis when medically necessary.
Complex cataract extraction is covered when the procedure requires insertion of iris retractors through additional incisions to maintain or improve exposure.

A59805 — Billing and Coding: Cataract Surgery

J05

L39905 — Cataract Surgery

J05

L33766 — Visual Field Examination

J09

A58592 — Billing and Coding: Cataract Extraction (including Complex Cataract Surgery)

J09

A57637 — Billing and Coding: Visual Field Examination

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