Does F68.A require prior authorization?

No, F68.A does not require prior authorization (high confidence). Covered without prior authorization.

`F68.A`, Factitious disorder imposed on another

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Billing, coding, and required claim documentation must follow the requirements specified in LCD L37633 (see that LCD for required medical records, prior authorization, and claim submission documentation).
Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.

Partial Hospitalization Program services that meet the coverage criteria of Local Coverage Determination L37633 are considered covered.
Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
A psychiatric diagnostic evaluation (CPT 90791) or with medical services (CPT 90792) may be performed once at the onset of an illness or suspected illness.
A psychiatric diagnostic evaluation (90791/90792) may be repeated for the same patient after an extended break (~6 months) in treatment, upon admission to inpatient psychiatric status, for a significant change in mental status, in a patient with established neurological disorder or dementia with acute/marked mental status change, or for a second opinion/diagnostic clarification.

A57480, Billing and Coding: Psychiatry and Psychology Services

WPS-J5-L34616, Psychiatry and Psychology Services

WPS-J8-L34616, Psychiatry and Psychology Services

A57780, Billing and Coding: Psychological and Neuropsychological Tests

FIRST_COAST-L33252

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