Does G40.919 require prior authorization?

No, G40.919 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`G40.919`, Epilepsy, unspecified, intractable, without status epilepticus

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

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.

The medical record must document the critical nature of the anatomy or other circumstances necessitating stereotactic treatment, the patient's functional status including Karnofsky Performance Status, the treatment date(s), and the current treatment dose.

Key Coverage Criteria

Stereotactic radiosurgery (SRS) is typically furnished as a single session; when more than one session is required, bill using stereotactic body radiation therapy (SBRT) codes instead of SRS codes.
Coverage on an individual (redetermination/appeal) basis may be considered for lesions that require a high radiation dose per fraction to avoid exposure of surrounding tissues when documentation and supporting literature are provided.
Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
Claims for drug screening services are payable under Medicare Part B only in these places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center — freestanding (50), rural health clinic — freestanding (72), and independent laboratory (81).
Ambulatory EEG is covered for diagnostic evaluation when seeking to detect clinical seizures or interictal epileptiform activity.

20 Active Policies

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L34394, Visual Fields Testing

J18

CGS-J18-L36029, Urine Drug Testing

J18

WPS-J5-L34645, Urine Drug Testing

A56915, Billing and Coding: Urine Drug Testing

NGS-J6-L35076, Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

A59416, Billing and Coding: Urine Drug Testing

A56551, Billing and Coding: Visual Fields Testing

NGS-J6-L39611, Urine Drug Testing

A56874, Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

NGS-J6-L33574, Visual Fields Testing

NGS-J6-L33399, EEG â Ambulatory Monitoring

A57030, Billing and Coding: EEG Ambulatory Monitoring

WPS-J8-L34645, Urine Drug Testing

FIRST_COAST-L34520, Psychological and Neuropsychological Tests

A57077, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

FIRST_COAST-L34521, Special EEG Tests

FIRST_COAST-L36393, Controlled Substance Monitoring and Drugs of Abuse Testing

A57667, Billing and Coding: Special EEG Tests

`G40.919`, Epilepsy, unspecified, intractable, without status epilepticus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G40.919, Epilepsy, unspecified, intractable, without status epilepticus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G40.919`, Epilepsy, unspecified, intractable, without status epilepticus