Does A85.8 require prior authorization?

No, A85.8 does not require prior authorization (high confidence). Covered without prior authorization.

`A85.8`, Other specified viral encephalitis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Claims should reference and be supported by LCD L34580 and follow the billing/coding guidelines in this article; specific documentation requirements (e.g., medical records, prior authorization) are those detailed in LCD L34580.
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.

Billing and coding for intravenous immunoglobulin (IVIG) should follow the Local Coverage Determination (LCD) L34580 and the billing/coding guidelines in this article as a complement to that LCD.
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.
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.

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

A58761, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

WPS-J5-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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