Does G31.09 require prior authorization?

No, G31.09 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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`G31.09`, Other frontotemporal neurocognitive disorder

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

Medical record must contain documentation supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM diagnosis code(s) that describe the patient's condition and reasons for the service; claims without a valid ICD-10-CM code will be returned as incomplete.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Key Coverage Criteria

Patient has an underlying physical illness or injury for which the HBAI service is intended.
There is documentation that biopsychosocial factors are significantly affecting treatment or medical management of the illness or injury.
Patient is alert, oriented, and has capacity to understand and respond meaningfully during a face-to-face encounter.
There is a documented need for psychological evaluation or intervention to successfully manage the patient's physical illness and activities of daily living.
The HBAI assessment is not duplicative of other provider assessments.
Reassessment is reasonable only when documentation shows a sufficient change in mental or medical status warranting re-evaluation of the patient's capacity to understand and cooperate with medical interventions.

20 Active Policies

CGS-J15-L34046, Speech-Language Pathology

J15

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

CGS-J18-L34046, Speech-Language Pathology

J18

CGS-J18-L34353, Outpatient Psychiatry and Psychology Services

J18

A56937, Billing and Coding: Psychiatry and Psychology Services

A52434, Health and Behavior Assessment/Intervention Medical Policy Article

NGS-J6-L33632, Psychiatry and Psychology Services

A59049, Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions

FIRST_COAST-L34520, Psychological and Neuropsychological Tests

A57780, Billing and Coding: Psychological and Neuropsychological Tests

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JH-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

NGS-JK-L33632, Psychiatry and Psychology Services

A54111, Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders

A57130, Billing and Coding: Psychiatric Codes

NOVITAS-JL-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

NOVITAS-JL-L35101, Psychiatric Codes

A53134, Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions

A56756, Billing and Coding: Home Health - Psychiatric Care

A56868, Billing and Coding: Outpatient Speech Language Pathology

`G31.09`, Other frontotemporal neurocognitive disorder

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G31.09, Other frontotemporal neurocognitive disorder

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G31.09`, Other frontotemporal neurocognitive disorder