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ICD-10-CM B69.0, Cysticercosis of central nervous system | No Prior Auth

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`B69.0`, Cysticercosis of central nervous system

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is 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.
D89.9 Disorder involving the immune mechanism, unspecified [Immune checkpoint inhibitor- related toxicity]
L40.0 - L40.4 L40.8 - L40.9 Psoriasis [age 4 and older]
L40.50 - L40.59 Arthropathic psoriasis [from age 2 years to age 18 and older]
L73.2 Hidradenitis suppurativa

2 Active Policies

AETNA-CPB-0315, Etanercept

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

Related Codes

70450(1 policies)70460(1 policies)70470(1 policies)70480(1 policies)70481(1 policies)70482(1 policies)70486(1 policies)70336(1 policies)

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Document pregnancy status or pregnancy planning (Appendix A: pregnancy or currently planning pregnancy listed as example clinical reason to avoid some systemic agents).

Document hepatitis B status and monitor for reactivation during and several months after therapy; if reactivation occurs, document consideration/administration of anti-viral therapy and stopping Enbrel if appropriate ("Monitor patients previously infected with hepatitis B virus for reactivation during and several months after therapy. If reactivation occurs, consider stopping Enbrel and beginning anti-viral therapy.").