Does G04.1 require prior authorization?

No, G04.1 does not require prior authorization (high confidence). Covered without prior authorization.

`G04.1`, Tropical spastic paraplegia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

A clinical history from the referral source indicating the need for testing must be available in the medical record and retrievable for review.
If an E/M service is billed as separate and identifiable, medical record must document medical necessity and the E/M CPT code must be billed with modifier 25.
Nerve conduction study reports must include numerical data (amplitude, latency, velocity) and F-wave descriptions must reference corresponding motor conduction data.
Blink reflex (CPT 95933) reports should include bilateral recordings with ipsilateral and contralateral stimulation and note presence or absence of R1 and R2 components.

Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.
EMG and/or nerve conduction studies are indicated for evaluation of suspected radiculopathy.
EMG and/or nerve conduction studies are indicated for evaluation of suspected mononeuropathy (single-nerve entrapment or injury).
EMG and/or nerve conduction studies are indicated for evaluation of suspected polyneuropathy or mononeuropathy multiplex.
EMG is indicated for evaluation of suspected myopathy.
EMG and nerve conduction studies are indicated for evaluation of suspected motor neuropathies (e.g., amyotrophic lateral sclerosis).

CGS-J15-L34056, Urodynamics

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J15-L35897

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