Does G44.001 require prior authorization?

No, G44.001 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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`G44.001`, Cluster headache syndrome, unspecified, intractable

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

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.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.

NUCCA assessment descriptions used in studies: objective x-ray views of the head and neck ("By using precise and objective x-ray views of the head and neck, mathematical measurement and analysis are made of the misalignment.") and clinical tests such as the supine leg check (leg length inequality), Anatometer (standing posture), Gravity Stress Analyzer, and hip calipers.

Key Coverage Criteria

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
NUCCA (National Upper Cervical Chiropractic Association) atlas realignment — pilot randomized, placebo-controlled study reported 'restoration of Atlas alignment was associated with marked and sustained reductions in BP similar to the use of 2-drug combination therapy' (Bakris et al., 2007) — i.e., potential benefit for stage 1 hypertension in a single-center pilot trial.
Chiropractic services are medically necessary when ALL of the following criteria are met: (1) the member has a neuromusculoskeletal disorder; (2) the medical necessity for treatment is clearly documented; and (3) improvement is documented within the initial 2 weeks of chiropractic care.
If improvement is not documented within the initial 2 weeks, additional chiropractic treatment is considered not medically necessary unless the chiropractic treatment is modified.
If no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is considered not medically necessary.

14 Active Policies

ANTHEM-SURG.00144, Occipital and Sphenopalatine Ganglion Nerve Block Therapy for the Treatment of Headache and Neuralgia

ANTHEM-SURG.00112, Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures)

ANTHEM-SURG.00096, Surgical and Ablative Treatments for Chronic Headaches

ANTHEM-CG-SURG-73, Balloon Sinus Ostial Dilation

AMBETTER-CP.VP.63, Visual Field Testing

AETNA-CPB-0083, Stereotactic Radiosurgery

AETNA-CPB-0107, Chiropractic Services

AETNA-CPB-0322, Attended Electroencephalographic (EEG) Video Monitoring

AETNA-CPB-0462, Headaches: Nonsurgical Management

AETNA-CPB-0647, Histamine Desensitization Therapy for Intractable Headaches

AETNA-CPB-0688, Intra-oral Appliances for Headaches and Trigeminal Neuralgia

AETNA-CPB-0707, Headaches: Invasive Procedures

A56612, Billing and Coding: CT of the Head

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

`G44.001`, Cluster headache syndrome, unspecified, intractable

Prior Authorization

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

G44.001, Cluster headache syndrome, unspecified, intractable

Prior Authorization

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

`G44.001`, Cluster headache syndrome, unspecified, intractable