Does G40.834 require prior authorization?

No, G40.834 does not require prior authorization (high confidence). Covered without prior authorization.

`G40.834`, Dravet syndrome, intractable, without status epilepticus

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.
For claims using CPT codes not listed in this article, submit supporting clinical and billing documentation for individual review.
A claim for the prior routine EEG must have been submitted to Medicare with a date of service within 1 year of the ambulatory EEG date of service; documentation/proof of that prior claim must be available.
When billing only the professional or the technical component, documentation must indicate which component was provided and support billing of that single component.

Ambulatory continuous EEG is covered only if a prior routine “resting” EEG was performed before the ambulatory EEG.
Routine EEGs covered under this policy are those described by CPT codes 95812, 95813, 95816, 95819, or 95822.
A routine EEG is defined as a recording of less than a 24-hour continuous duration.
Visual field testing is covered when billed to the Part A or Part B MAC with a valid ICD-10-CM diagnosis code that best describes the patient’s condition and when the service is reasonable and necessary.
For diagnostic visual field tests, report the test result on the claim if known; if the result is not known, report the signs or symptoms that prompted the test.
If the service requires a referring/ordering physician, include the ordering/referring physician’s name and NPI on the claim.

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J18-L34394, Visual Fields Testing

J18

A57030, Billing and Coding: EEG Ambulatory Monitoring

NGS-J6-L33399, EEG â Ambulatory Monitoring

A57780, Billing and Coding: Psychological and Neuropsychological Tests

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