H52.203 — Unspecified astigmatism, bilateral
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation that the patient has received refractive hardware must be maintained.
- Acceptable delivery methods to document receipt: member or authorized representative picks up at optical shop; delivery by mail or delivery service; delivery to a nursing facility on behalf of the member.
- Use the delivery date as the date of service on the claim (date beneficiary or authorized representative picks up the refractive hardware, or date shipped if mailed).
- Reference the member's plan specifics to determine coverage, frequency, and applicable codes for frames and lenses.
Key Coverage Criteria
- Coverage and frequency of frames and lenses are determined by the member's plan specifics and apply as stated in the member's plan.
- Lens add-ons may be covered when permitted by the member's specific reference plan benefits and medical necessity determinations.
- Fitting of spectacles including measurement of anatomical facial characteristics, writing of laboratory specifications, and final adjustment of spectacles to the visual axis and anatomical topography.
- Dispensing a complete set of glasses (frame and two lenses) with associated fitting services as part of a preventive (routine) eye examination.
- Coverage for contact lenses is determined by the member's specific plan; refer to the member's plan specifics for coverage applicability.
- Hypermetropia (farsightedness) — unspecified, right, left, or bilateral (H52.00–H52.03).
1 Active Policy
AMBETTER-CP.VP.13-Attachment-A-Refractive-Hardware — Preventive (Routine) Eye Examination Attachment A: Refractive Hardware
Related Codes
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