H40.2290 — Chronic angle-closure glaucoma, unspecified eye, stage unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- A claim submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code(s) must best describe the patient's condition for which the service was performed.
- For diagnostic tests, report the test result if known; otherwise report the symptoms that prompted the test.
- The patient’s medical record must include assessment by the ordering provider related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report.
Key Coverage Criteria
- Ophthalmic biometry using CPT 76519 (A-scan) or CPT 92136 (optical coherence biometry) is payable under Medicare Part B when performed for intraocular lens (IOL) power calculation.
- The global service (76519 or 92136 global) is payable in the office (place of service 11) and independent clinic (49).
- The technical component (TC) of CPT 76519 or 92136 is payable in the office (11), independent clinic (49), federally qualified health center (50), and rural health clinic (72).
- The professional component (26) of CPT 76519 is payable in office (11), off-campus outpatient hospital (19), inpatient hospital (21), on-campus outpatient hospital (22), ambulatory surgical center (24), and independent clinic (49).
- The professional component (26) of CPT 92136 is payable in office (11), off-campus outpatient hospital (19), inpatient hospital (21), on-campus outpatient hospital (22), and independent clinic (49).
- Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
4 Active Policies
A57637 — Billing and Coding: Visual Field Examination
J09
L33766 — Visual Field Examination
J09
A57070 — Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation
L34181 — Ophthalmic Biometry for Intraocular Lens Power Calculation
Related Codes
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