Does G40.813 require prior authorization?

No, G40.813 does not require prior authorization (high confidence). Covered without prior authorization.

`G40.813`, Lennox-Gastaut syndrome, intractable, with status epilepticus

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

Ambulatory EEG is covered for diagnostic evaluation when seeking to detect clinical seizures or interictal epileptiform activity.
Ambulatory EEG is covered for pre-surgical evaluation to localize seizure onset when capture of multiple seizures is needed for surgical planning.
Ambulatory EEG is covered for routine follow-up monitoring of known seizure disorder or previously identified epileptiform activity.
Bill HCPCS code G0278 for femoral or iliac angiography performed at the time of coronary angiography.
Aortography and peripheral angiography are covered when reasonable and necessary per Local Coverage Determination L36767 and when documentation supports the selected ICD-10-CM diagnosis and medical necessity.
Special EEG tests are covered only when they meet the reasonable and necessary requirements described in Local Coverage Determination (LCD) L34521.

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J18-L34394, Visual Fields Testing

J18

NGS-J6-L33399, EEG â Ambulatory Monitoring

A56551, Billing and Coding: Visual Fields Testing

NGS-J6-L39995, Pharmacogenomic Testing

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