Does H40.10X4 require prior authorization?

No, H40.10X4 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H40.10X4` — Unspecified open-angle glaucoma, indeterminate stage

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
Corneal pachymetry (measurement of corneal thickness) is covered to evaluate patients with a diagnosis of increased intraocular pressure.
Repeat corneal pachymetry is covered after interval corneal trauma or corneal surgery to reassess corneal thickness.
Corneal pachymetry is generally covered when performed as indicated by current medical literature or accepted standards of practice for clinical management.
CPT 66991 may be reported for noncomplex cataract removal with intraocular lens (IOL) implant performed with concomitant intraocular aqueous drainage device insertion (e.g., iStent) when the medically reasonable and necessary criteria in the related LCD are met.
CPT 66989 may be reported for complex cataract removal with IOL implant performed with concomitant intraocular aqueous drainage device insertion when the medically reasonable and necessary criteria in the related LCD are met.

A59807 — Billing and Coding: Micro-Invasive Glaucoma Surgery

J05

A56916 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

L34615 — Visual Fields

J05

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

L39907

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