Does G20.A1 require prior authorization?

No, G20.A1 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`G20.A1`, Parkinson's disease without dyskinesia, without mention of fluctuations

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

All documentation must be available upon request and the medical record must support the medical necessity and frequency of treatment.
The medical record must document the critical nature of the anatomy or other circumstances necessitating stereotactic treatment, the patient's functional status including Karnofsky Performance Status, the treatment date(s), and the current treatment dose.
When requesting individual consideration at redetermination, providers must submit all relevant medical records and supporting literature, including at minimum two Phase II studies or one Phase III study for Contractor Medical Director review.

Key Coverage Criteria

Stereotactic radiosurgery (SRS) is typically furnished as a single session; when more than one session is required, bill using stereotactic body radiation therapy (SBRT) codes instead of SRS codes.
Coverage on an individual (redetermination/appeal) basis may be considered for lesions that require a high radiation dose per fraction to avoid exposure of surrounding tissues when documentation and supporting literature are provided.
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.

20 Active Policies

CGS-J15-L34046, Speech-Language Pathology

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L34056, Urodynamics

J15

CGS-J15-L37790, Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions

J15

CGS-J18-L34046, Speech-Language Pathology

J18

CGS-J18-L37790, Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L34056, Urodynamics

J18

WPS-J5-L35124, Autonomic Function Testing

A57551, Billing and Coding: Autonomic Function Testing

A56874, Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

A56937, Billing and Coding: Psychiatry and Psychology Services

A57455, Billing and Coding: Urodynamics

NGS-J6-L36236, Autonomic Function Testing

NGS-J6-L35076, Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

A57024, Billing and Coding: Autonomic Function Testing

NGS-J6-L33632, Psychiatry and Psychology Services

NGS-J6-L33576, Urodynamics

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

`G20.A1`, Parkinson's disease without dyskinesia, without mention of fluctuations

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G20.A1, Parkinson's disease without dyskinesia, without mention of fluctuations

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G20.A1`, Parkinson's disease without dyskinesia, without mention of fluctuations