Does T26.20XA require prior authorization?

No, T26.20XA does not require prior authorization (high confidence). Code is covered without prior authorization.

`T26.20XA` — Burn with resulting rupture and destruction of unspecified eyeball, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

List the appropriate CPT code for the procedure and include any applicable modifiers; adhere to Medicare global surgery and CCI (correct coding initiative) rules for eyelid surgeries.
Submit physicians' services and diagnostic tests with a diagnosis code that supports medical necessity and code to the greatest level of specificity (full digit completeness).
Use the diagnosis code based on diagnostic test results as the primary diagnosis; if test results are normal or inconclusive, use the diagnosis code for the sign or symptom that prompted the test as the primary diagnosis.
When signs or symptoms are present, place the appropriate definitive diagnosis code in the first position and an available symptom diagnosis code in the second position on CMS-1500 item 21 (or electronic equivalent).

Blepharoplasty, blepharoptosis repair, or brow lift is covered when documented signs or symptoms of a functional abnormality of the upper eyelids are present as defined by the associated LCD (L34528).
No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
Upper blepharoplasty or ptosis repair is medically necessary when upper eyelid or brow descent produces functional visual complaints (visual field impairment in primary gaze or down-gaze/reading).
Upper blepharoplasty is indicated for chronic eyelid dermatitis caused by redundant eyelid skin.
Patients with an anophthalmic socket experiencing ptosis or difficulty with an ocular prosthesis are candidates for blepharoptosis surgery without required visual field testing.
Brow ptosis that produces or contributes to functional visual impairment is an indication for brow lift surgery.

A56908 — Billing and Coding: Blepharoplasty, Blepharoptosis and Brow Lift

J05

L34528 — Blepharoplasty, Blepharoptosis and Brow Lift

J05

A57205 — Billing and Coding: Oximetry Services

J12

L35434 — Oximetry Services

J12

A59186 — Billing and Coding: Magnesium

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