Does H35.101 require prior authorization?

No, H35.101 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H35.101` — Retinopathy of prematurity, unspecified, right eye

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
The diagnosis code(s) submitted must best describe the patient's condition for which the service was performed and must be a valid ICD-10-CM code.
Use modifiers LT/RT to indicate the operative site and use modifier -50 if both eyes are treated on the same day/session.

Panretinal (scatter) laser photocoagulation (PRP) is covered when medically necessary and supported by the Local Coverage Determination (LCD) and the patient's medical record.
Coverage for electroretinography (ERG) is determined by Local Coverage Determination (LCD) L37371; ERG is covered only when reasonable and necessary per LCD L37371.
SCODI (CPT 92133) is covered when performed to evaluate or monitor optic nerve damage/optic neuropathy.
SCODI (CPT 92134) is covered for management of retinal diseases including wet age-related macular degeneration/choroidal neovascularization, macular edema, diabetic retinopathy (proliferative and nonproliferative), branch retinal vein occlusion, central retinal vein occlusion, and cystoid macular edema.
SCODI may be covered monthly (one scan per eye) for patients undergoing active intravitreal drug treatment for retinal disease.
SCODI may be covered monthly for other retinal/macular conditions undergoing rapid clinical change requiring aggressive therapy or frequent follow-up (examples: macular hole, traction retinal detachment).

L37015 — Visual Electrophysiology Testing

J05

A57599 — Billing and Coding: Visual Electrophysiology Testing

J05

A57483 — Billing and Coding: Visual Fields

J05

L34615 — Visual Fields

J05

A56550 — Billing and Coding: Panretinal (Scatter) Laser Photocoagulation

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