Does G31.9 require prior authorization?

No, G31.9 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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`G31.9`, Degenerative disease of nervous system, unspecified

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 records must be maintained and available upon request, be legible, include complete patient identification and dates of service, and contain the legible signature of the physician or non‑physician practitioner responsible for care.
The submitted medical record must support the selected ICD‑10‑CM diagnosis code(s) and the CPT/HCPCS code billed must accurately describe the service performed.
When FDG PET is performed in the context of a CMS‑approved practical clinical trial using a specific protocol, the claim should be reported with modifier Q0.

Key Coverage Criteria

FDG PET (CPT 78608 / HCPCS A9552) is covered to differentiate Alzheimer's disease (AD) from frontotemporal dementia (FTD) in patients with a recent dementia diagnosis who have documented cognitive decline for at least 6 months and who meet diagnostic criteria for both AD and FTD.
FDG PET is covered for patients with mild cognitive impairment (MCI) or early dementia only when performed as part of a CMS‑approved practical clinical trial (coverage with evidence development).
FDG PET (CPT 78608) is covered for intractable seizures only when used as part of a pre‑surgical evaluation for seizure focus localization.
Speech-language pathology (SLP) services for treatment or evaluation of communication disorders when determined reasonable and necessary per LCD L35070.
Selection and prescription of speech-generating devices should be billed with CPT code 92607.
Adaptation and training for speech-generating devices should be billed with CPT code 92609.

20 Active Policies

A56937, Billing and Coding: Psychiatry and Psychology Services

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

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

NOVITAS-JH-L35101, Psychiatric Codes

NGS-JK-L33632, Psychiatry and Psychology Services

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

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

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

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

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

AETNA-CPB-0158, Neuropsychological and Psychological Testing

ANTHEM-MP-B094276, TRANS.00035 Therapeutic use of Stem Cells, Blood and Bone Marrow Products

AMBETTER-CP.MP.134, Evoked Potential Testing

CIGNA-0069, Airway Clearance Devices in the Ambulatory Setting

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

ANTHEM-CG-LAB-20, Thyroid Testing

AETNA-CPB-0271, Wheelchairs and Power Operated Vehicles (Scooters)

AETNA-CPB-0344, Optic Nerve and Retinal Imaging Methods

`G31.9`, Degenerative disease of nervous system, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G31.9, Degenerative disease of nervous system, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G31.9`, Degenerative disease of nervous system, unspecified