Does H40.1193 require prior authorization?

No, H40.1193 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H40.1193` — Primary open-angle glaucoma, unspecified eye, severe stage

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Medical record documentation by the ordering/referring physician must state the clinical indication/medical necessity for the test and include the test results.
If the performing provider is different from the ordering/referring physician, the performing provider must maintain hard copy test results and interpretation plus copies of the ordering/referring physician's order.
Documentation should contain a history and physical (H&P) supporting the diagnosis for which the corneal pachymetry is being rendered.

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.
Fundus photography is covered when medical necessity is documented in the medical record, including relevant history, exam, diagnostic test results, and retention of the photographs and an interpretation/report.
Extended ophthalmoscopy is covered when medical necessity is documented for each eye, including relevant history, physical exam, pertinent diagnostic results, and retinal drawings that meet the policy specifications.
Patients actively receiving intravitreal injections for exudative age-related macular degeneration (ICD H35.3210-H35.3213, H35.3220-H35.3223, H35.3230-H35.3233) may require and are covered for extended ophthalmoscopy.

A56548 — Billing and Coding: Corneal Pachymetry

J06

A56551 — Billing and Coding: Visual Fields Testing

J06

A56726 — Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J06

L33630 — Corneal Pachymetry

J06

L33574

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