H52.213 — Irregular astigmatism, bilateral
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted the test.
- The patient medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
- For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
- All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.
Key Coverage Criteria
- Computerized corneal topography is billable when performed as a diagnostic test for corneal conditions and the claim includes a diagnosis code that best describes the patient's condition for which the service was performed.
- Pre-operative corneal topography for intraocular lens power determination in cataract surgery when irregular astigmatism is present.
- Corneal topography to evaluate monocular diplopia when the diplopia is suspected to be caused by corneal irregularity.
- Corneal topography for diagnosis of early keratoconus.
- Corneal topography for post-surgical or post-traumatic astigmatism measuring at least 3.5 diopters.
- Corneal topography when irregular astigmatism is suspected based on retinoscopic streak or conventional keratometry findings.
4 Active Policies
AMBETTER-CP.VP.13 — Preventative (Routine) Eye Examination
AMBETTER-CP.VP.13-Attachment-A-Refractive-Hardware — Preventive (Routine) Eye Examination Attachment A: Refractive Hardware
A56816 — Billing and Coding: Computerized Corneal Topography
L34008 — Computerized Corneal Topography
Related Codes
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