Does D44.4 require prior authorization?

No, D44.4 does not require prior authorization (high confidence). Covered without prior authorization.

`D44.4`, Neoplasm of uncertain behavior of craniopharyngeal duct

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When the service is performed in a hospital inpatient or outpatient setting, use modifier -26 to indicate the professional component.
Billing and coding must adhere to the coverage indications, limitations, and medical necessity criteria described in the associated LCD L34615 Visual Fields; follow that LCD for clinical eligibility and documentation requirements.
Prior to billing Medicare, verify applicable code combinations and correct coding guidelines with the CCI (Correct Coding Initiative).
The medical record must document medical necessity including relevant history, physical examination, and results of pertinent diagnostic tests or procedures.

Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
Somatosensory testing is covered when medically reasonable and necessary and documented in the patient's medical record (relevant history, physical exam, and pertinent diagnostic test results).
Testing and interpretation are covered when ordered and/or furnished by qualified personnel who have documented training and experience in evoked potentials and electrodiagnostics per CMS guidance (accredited residency/fellowship, national certification, or accredited post-graduate training/AMA-AOA Category 1 CME).

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L34394

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