Does H49.9 require prior authorization?

No, H49.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H49.9` — Unspecified paralytic strabismus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For claims requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
The medical record must include the ordering provider's assessment related to the visit, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report.
For botulinum toxin coverage, medical records must document medical necessity for treatment.
For spastic conditions other than upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia or other focal dystonias, documentation must state the condition was unresponsive to conventional treatment and include the covered diagnosis, dosages, injection sites, frequencies, EMG necessity if used, and description of treatment effectiveness.

Medicare covers botulinum toxin injections for medically necessary treatment of spastic conditions including upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia, and other focal dystonias.
Medicare will reimburse unused portions of reconstituted botulinum toxin when the medical record documents the precise amount administered and the amount discarded.
Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
Visual field testing is covered when billed to the Part A or Part B MAC with a valid ICD-10-CM diagnosis code that best describes the patient’s condition and when the service is reasonable and necessary.
For diagnostic visual field tests, report the test result on the claim if known; if the result is not known, report the signs or symptoms that prompted the test.
If the service requires a referring/ordering physician, include the ordering/referring physician’s name and NPI on the claim.

A57474 — Billing and Coding: Botulinum Toxin Type A & Type B

J05

A59808 — Billing and Coding: Botulinum Toxin Injections

J05

L34635 — Botulinum Toxin Type A & Type B

J05

L39908 — Botulinum Toxin Injections

J05

A59706 — Billing and Coding: Botulinum Toxin Injections

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