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ICD-10-CM A83.9, Mosquito-borne viral encephalitis, unspecified | No Prior Auth

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`A83.9`, Mosquito-borne viral encephalitis, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
For claims using CPT codes not listed in this article, submit supporting clinical and billing documentation for individual review.
A claim for the prior routine EEG must have been submitted to Medicare with a date of service within 1 year of the ambulatory EEG date of service; documentation/proof of that prior claim must be available.
When billing only the professional or the technical component, documentation must indicate which component was provided and support billing of that single component.

Key Coverage Criteria

Ambulatory continuous EEG is covered only if a prior routine “resting” EEG was performed before the ambulatory EEG.
Routine EEGs covered under this policy are those described by CPT codes 95812, 95813, 95816, 95819, or 95822.
A routine EEG is defined as a recording of less than a 24-hour continuous duration.

2 Active Policies

A56612, Billing and Coding: CT of the Head

A56771, Billing and Coding: Special Electroencephalography

Related Codes

A83.1(2 policies)A83.4(2 policies)A39.81(2 policies)A83.0(2 policies)A83.2(2 policies)A83.3(2 policies)A17.82(2 policies)A83.5(2 policies)

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