Does G35.C0 require prior authorization?

No, G35.C0 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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`G35.C0`, Secondary progressive multiple sclerosis, 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

Active urinary infection must be treated and the effectiveness of treatment observed and documented prior to performing urodynamic testing.
An initial evaluation (history, physical exam, and urinalysis with microscopy) must be completed and documented before urodynamic testing.
Medical record must clearly document signs and symptoms of voiding dysfunction and the specific tests performed must be appropriate to analyze those signs and symptoms or to guide medical/surgical decisions.

Key Coverage Criteria

Urodynamics is indicated after failure to respond to an adequate therapeutic trial.
Urodynamic testing is covered when medically necessary to assist in diagnosing urologic dysfunction after an initial evaluation including history, physical exam, and urinalysis with microscopy has been performed.
Urodynamics is indicated when the diagnosis is uncertain and an appropriate treatment plan cannot be developed from the basic evaluation.
Urodynamic testing is indicated when consideration of urologic surgical intervention is required, particularly if prior surgery failed or the patient is high surgical risk.
Urodynamic testing is indicated for incontinence associated with recurrent symptomatic urinary tract infection.
Urodynamics is indicated for persistent symptoms of difficult bladder emptying or abnormal post-void residual on urinalysis.

20 Active Policies

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J15-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J15

CGS-J15-L35891, Intravenous Immune Globulin

J15

CGS-J15-L34056, Urodynamics

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

J15

CGS-J15-L38920, Off-label Use of Rituximab and Rituximab Biosimilars

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L38920, Off-label Use of Rituximab and Rituximab Biosimilars

J18

CGS-J18-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J18

CGS-J18-L35891, Intravenous Immune Globulin

J18

CGS-J18-L34246, Routine Foot Care and Debridement of Nails

J18

CGS-J18-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J18

CGS-J18-L34056, Urodynamics

J18

CGS-J18-L34394, Visual Fields Testing

J18

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L39857, Botulinum Toxin Injections

J18

`G35.C0`, Secondary progressive multiple sclerosis, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G35.C0, Secondary progressive multiple sclerosis, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G35.C0`, Secondary progressive multiple sclerosis, unspecified