Does H44.2C3 require prior authorization?

No, H44.2C3 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H44.2C3` — Degenerative myopia with retinal detachment, bilateral

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Explicit clinical documentation is required to justify any treatment frequency that is more frequent than approximately every 4 weeks in a given eye.
For Part B claims, enter 'Intravitreal bevacizumab, [dose] mg' in Item 19 of the CMS-1500 or in Loop 2300/2400 NTE01 (NTE, 02) for electronic claims.
When billing J7999, enter '1' in the days/units field for one eye or '2' if both eyes are treated in the same encounter.
When billing CPT 67028, use modifier RT or LT to indicate the eye treated; if billing bilateral use modifier 50.

When intravitreal bevacizumab is acquired from a compounding source or compounded in the physician's facility/office, bill using HCPCS J7999 on claims.
HCPCS J7999 shall be used for all compounded injectable drugs (not restricted to bevacizumab).
For Part A claims for intravitreal compounded bevacizumab, bill using HCPCS C9257 and provide the number of units.
Use scanning computerized ophthalmic diagnostic imaging (CPT 92134) at 4–6 week intervals when appropriate to evaluate need for re-treatment.
Extended ophthalmoscopy (CPT 92201, 92202) is payable when documented as an extended ophthalmoscopy that meets indicated standards (e.g., includes a retinal drawing or equivalent documentation) beyond a general ophthalmologic exam.
Fundus photography (CPT 92227, CPT 92228) is covered when ordered by the treating physician or other treating practitioner acting within the scope of his/her license and Medicare requirements.

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

J06

L33574 — Visual Fields Testing

J06

L33567 — Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J06

L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J06

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