Does H40.20X1 require prior authorization?

No, H40.20X1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H40.20X1` — Unspecified primary angle-closure glaucoma, mild stage

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.
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).
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.

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

J05

A57483 — Billing and Coding: Visual Fields

J05

L34615 — Visual Fields

J05

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

L33567

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