Does S04.031D require prior authorization?

No, S04.031D does not require prior authorization (high confidence). Code is covered without prior authorization.

`S04.031D` — Injury of optic tract and pathways, right side, subsequent encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis

A57599 — Billing and Coding: Visual Electrophysiology Testing

J05

L37015 — Visual Electrophysiology Testing

J05

A56551 — Billing and Coding: Visual Fields Testing

J06

L36831 — Visual Electrophysiology Testing

J06

A57060 — Billing and Coding: Visual Electrophysiology Testing

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