Does G25.9 require prior authorization?

No, G25.9 does not require prior authorization (high confidence). Covered without prior authorization.

`G25.9`, Extrapyramidal and movement disorder, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
When required, report the referring/ordering physician's name and NPI on the claim.

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.
Interactive complexity add-on code 90785 may be reported in conjunction with specified diagnostic and psychotherapy codes when interactive complexity is present.
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.

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L34353, Outpatient Psychiatry and Psychology Services

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

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