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ICD-10-CM A88.1, Epidemic vertigo | No Prior Auth

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`A88.1`, Epidemic vertigo

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

Key Coverage Criteria

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.
children and adolescents with mental illness
Mounted equine-assisted therapies (horse riding) as a component of EAT programs
Stroke (post-stroke hemiparesis; post-stroke patients in the 1st year post-stroke)
post-stroke patients with hemiparesis

2 Active Policies

AETNA-CPB-0151, Hippotherapy

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

Related Codes

H81.01(2 policies)R48.0(2 policies)G30.0(2 policies)G80.0(2 policies)R25.0(2 policies)R42(2 policies)F01.50(2 policies)R63.2(2 policies)

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No documentation requirements are specified in this Clinical Policy Bulletin. (The document does not list required medical records, test results, or specific clinical documentation for coverage because the service is classified as experimental/investigational and not covered for the listed indications.)

No explicit medical record or documentation requirements are specified in this document/chunk