Does G43.719 require prior authorization?

No, G43.719 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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`G43.719`, Chronic migraine without aura, 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

All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s), the submitted CPT/HCPCS code must describe the service performed, and the record must clearly document medical necessity, the indication for ordering the test, and a clear diagnostic impression.

Key Coverage Criteria

Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
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).

20 Active Policies

CGS-J15-L39856, Botulinum Toxin Injections

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

CGS-J18-L39856, Botulinum Toxin Injections

J18

A57483, Billing and Coding: Visual Fields

WPS-J5-L39908, Botulinum Toxin Injections

WPS-J5-L34615, Visual Fields

WPS-J5-L40381, Botulinum Toxin Injections

WPS-J5-L39909, Botulinum Toxin Injections

NGS-J6-L39832, Botulinum Toxin Injections

WPS-J8-L39909, Botulinum Toxin Injections

WPS-J8-L39908, Botulinum Toxin Injections

WPS-J8-L40381, Botulinum Toxin Injections

WPS-J8-L34615, Visual Fields

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

FIRST_COAST-L33766, Visual Field Examination

FIRST_COAST-L33274, Botulinum Toxins

FIRST_COAST-L40025, Botulinum Toxins

A57637, Billing and Coding: Visual Field Examination

`G43.719`, Chronic migraine without aura, intractable, without status migrainosus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G43.719, Chronic migraine without aura, intractable, without status migrainosus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G43.719`, Chronic migraine without aura, intractable, without status migrainosus