Does G43.109 require prior authorization?

No, G43.109 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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`G43.109`, Migraine with aura, not intractable, without status migrainosus

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.

Key Coverage Criteria

Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Visual field testing is medically necessary after a significant eye injury when field loss is suspected or needs evaluation.

20 Active Policies

CGS-J15-L39856, Botulinum Toxin Injections

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J18-L34394, Visual Fields Testing

J18

CGS-J18-L39856, Botulinum Toxin Injections

J18

CGS-J18-L39857, Botulinum Toxin Injections

J18

WPS-J5-L40381, Botulinum Toxin Injections

A57483, Billing and Coding: Visual Fields

WPS-J5-L34615, Visual Fields

WPS-J5-L39909, Botulinum Toxin Injections

WPS-J5-L39908, Botulinum Toxin Injections

A56551, Billing and Coding: Visual Fields Testing

NGS-J6-L33574, Visual Fields Testing

NGS-J6-L39832, Botulinum Toxin Injections

WPS-J8-L40381, Botulinum Toxin Injections

WPS-J8-L39909, Botulinum Toxin Injections

WPS-J8-L39908, Botulinum Toxin Injections

WPS-J8-L34615, Visual Fields

A57637, Billing and Coding: Visual Field Examination

FIRST_COAST-L33766, Visual Field Examination

`G43.109`, Migraine with aura, not intractable, without status migrainosus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G43.109, Migraine with aura, not intractable, without status migrainosus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G43.109`, Migraine with aura, not intractable, without status migrainosus