Does H40.1420 require prior authorization?

No, H40.1420 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H40.1420` — Capsular glaucoma with pseudoexfoliation of lens, left eye, stage unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The medical record must include the ordering provider's assessment relevant to the patient's complaint for that visit.
The medical record must include relevant medical history related to the service.
The medical record must include results of pertinent tests and procedures; for diagnostic tests report the actual test result if known, otherwise report the symptoms prompting the test.
All office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.

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.
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.

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

J05

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

A56551 — Billing and Coding: Visual Fields Testing

J06

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

J06

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