Does G25.0 require prior authorization?

No, G25.0 does not require prior authorization (high confidence). Covered without prior authorization.

`G25.0`, Essential tremor

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
If billing more than allowed units of CPT 77334 (total units >6 or units > isocenters+3), document factors such as multiple isocenters, target volume irregularity, proximity to critical structures, or other reasons justifying additional dosimetry/treatment device units.

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.
Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Unilateral MRgFUS thalamotomy is medically reasonable and necessary for medication-refractory Essential Tremor defined as refractory to at least two trials of medical therapy including at least one first-line agent.

CGS-J15-L39857, Botulinum Toxin Injections

J15

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

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

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

J18

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