Does T26.21XA require prior authorization?

No, T26.21XA does not require prior authorization (high confidence). Code is covered without prior authorization.

`T26.21XA` — Burn with resulting rupture and destruction of right eyeball, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Billing and coding for immunizations must follow the coverage indications, limitations, and medical necessity criteria set forth in the associated Local Coverage Determination LCD L34596 (Immunizations).
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.

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).
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis
H44.532 | Leucocoria, left eye
H44.533 | Leucocoria, bilateral

L34528 — Blepharoplasty, Blepharoptosis and Brow Lift

J05

L34596 — Immunizations

J05

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

J05

A56900 — Billing and Coding: Immunizations

J05

A58873 — Billing and Coding: Tetanus Immunization

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