Does G31.81 require prior authorization?

No, G31.81 does not require prior authorization (high confidence). Covered without prior authorization.

`G31.81`, Alpers disease

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Rheumatoid arthritis pain (studied comparison vs guided imagery)
Primary dysmenorrhea (protocols exist to study EMDR effects)
Anxiety disorders (including general anxiety, specific phobia, panic)
Obsessive-compulsive disorder (EMDR vs CBT compared in RCTs)

AMBETTER-CP.MP.99, Wheelchair Seating

CIGNA-0069, Airway Clearance Devices in the Ambulatory Setting

CIGNA-0567, Serum Folate and Red Blood Cell Folate Testing

AETNA-CPB-0583, Eye Movement Desensitization and Reprocessing (EMDR) Therapy

AETNA-CPB-0763, Homocysteine Testing

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