Does G44.011 require prior authorization?

No, G44.011 does not require prior authorization (high confidence). Covered without prior authorization.

`G44.011`, Episodic cluster headache, intractable

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Documentation and supporting information must be available to Medicare upon request.

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.
Malpositioning of the upper eyelid, including dermatochalasia, blepharochalasia, blepharoptosis, brow ptosis, or eyelid injury.
Glaucoma or glaucoma suspect status requiring evaluation or monitoring.
Diabetic retinopathy and/or hypertensive retinopathy.
Macular pathology, including macular degeneration.

AMBETTER-CP.VP.63, Visual Field Testing

A56612, Billing and Coding: CT of the Head

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

Ask Backwork about documentation requirements, denial risks, or coverage in your state.