Does G43.E09 require prior authorization?

No, G43.E09 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

`G43.E09`, Chronic 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

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Botulinum toxin administration is covered when it meets the reasonable and necessary requirements of LCD L33274.
Use of botulinum toxin for management of chronic migraine is supported when documentation shows a history of migraines occurring greater than or equal to 15 days per month.
Botulinum toxin is covered for management of chronic migraine when documentation supports migraines occurring >=15 days per month.
Coverage is permitted only when services meet the reasonable and necessary requirements of LCD L38809.
Initial onabotulinumtoxinA dosing for blepharospasm is 1.25–2.5 Units into each of three sites per affected eye.

20 Active Policies

CGS-J15-L39856, Botulinum Toxin Injections

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J18-L39856, Botulinum Toxin Injections

J18

CGS-J18-L39857, Botulinum Toxin Injections

J18

WPS-J5-L39908, Botulinum Toxin Injections

WPS-J5-L39909, Botulinum Toxin Injections

WPS-J5-L40381, Botulinum Toxin Injections

NGS-J6-L33574, Visual Fields Testing

NGS-J6-L39832, Botulinum Toxin Injections

A56551, Billing and Coding: Visual Fields Testing

WPS-J8-L40381, Botulinum Toxin Injections

WPS-J8-L39908, Botulinum Toxin Injections

WPS-J8-L39909, Botulinum Toxin Injections

FIRST_COAST-L33766, Visual Field Examination

A57715, Billing and Coding: Botulinum Toxins

A57637, Billing and Coding: Visual Field Examination

FIRST_COAST-L33274, Botulinum Toxins

FIRST_COAST-L40025, Botulinum Toxins

NOVITAS-JH-L38809, Botulinum Toxins

A58423, Billing and Coding: Botulinum Toxins

`G43.E09`, Chronic 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.E09, Chronic 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.E09`, Chronic migraine with aura, not intractable, without status migrainosus