Does F51.04 require prior authorization?

No, F51.04 does not require prior authorization (high confidence). Covered without prior authorization.

`F51.04`, Psychophysiologic insomnia

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.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be available to the contractor upon request.
The record must identify the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

Drug testing services are covered when they meet the medical necessity and coverage indications specified in LCD L36029.
Medicare Part B will pay for drug screening services when furnished in allowed places of service: office (11), urgent care (20), independent clinic (49), FQHC freestanding (50), RHC freestanding (72), and independent laboratory (81).
Psychiatric/psychological services are covered when there is a reasonable expectation that withdrawing treatment would cause the patient's condition to deteriorate, relapse, or require hospitalization.
CORF social and psychological services are covered when indicated and may be provided by qualified social workers (minimum BS) or psychologists (minimum Master’s level).
Psychiatric diagnostic procedures may be billed once per day and are covered at the outset of an illness or suspected illness, or again for a new episode after a hiatus or on (re)admission for complications of the underlying condition.
Psychotherapy codes that include an E/M component are payable when performed by physicians, physician assistants (PA), nurse practitioners (NP), or clinical nurse specialists (CNS) and the E/M component is documented in the record.

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

CGS-J18-L36029, Urine Drug Testing

J18

CGS-J18-L34353, Outpatient Psychiatry and Psychology Services

J18

NGS-J6-L33632

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