Does A92.31 require prior authorization?

No, A92.31 does not require prior authorization (high confidence). Covered without prior authorization.

`A92.31`, West Nile virus infection with encephalitis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.

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.
Off-label IVIG use may be billed when supported by the applicable Local Coverage Determination (LCD) and by documentation of medical necessity; off-label is defined as not in Medicare-approved compendia or the FDA label.

NGS-J6-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

A59105, Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)

NGS-JK-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

A56771, Billing and Coding: Special Electroencephalography

A57204

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