H40.069 — Primary angle closure without glaucoma damage, unspecified eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For Er:YAG laser for diffuse actinic cheilitis: biopsy results demonstrating no evidence of high-grade dysplasia or cancer.
- Any use of procedures listed as covered 'if selection criteria are met' should be supported in the medical record by the specific clinical findings and measurements required by the selection criteria (e.g., BCVA, exam findings, symptom descriptions, prior treatments tried and failed).
- For Nd:YAG posterior capsulotomy: documentation of eye exam confirming diagnosis of posterior capsular opacification and exclusion of other ocular causes of functional impairment (document: “The eye examination should confirm the diagnosis of posterior capsular opacification and exclude other ocular causes of functional impairment.”).
- For cases of Nd:YAG capsulotomy performed within 6 months of cataract surgery: documentation/review demonstrating reasonableness and medical necessity because opacification is rare within first 6 months (document: “any cases of Nd:YAG laser capsulotomy occurring within 6 months of cataract surgery should be reviewed, to ensure that Nd:YAG laser capsulotomy is reasonable and medically necessary”).
Key Coverage Criteria
- Laser adjuncts / debridement for peri-implantitis and periodontal conditions
- Er:YAG laser use for reductions in post-op pain/edema (e.g., third molar removal) and other oral/jaw conditions
- Physical and laser therapies for genitourinary syndrome of menopause / vulvovaginal atrophy
- Laser approaches to prevent posterior capsule opacification
- Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women
- Laser therapy for overactive bladder (non-ablative vaginal erbium:YAG) comparisons with pharmacotherapy
2 Active Policies
AETNA-CPB-0354 — YAG Laser in Ophthalmology and Other Selected Indications
ANTHEM-CG-SURG-100 — CG-SURG-100 Laser Trabeculoplasty and Laser Peripheral Iridotomy
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.