Does G44.031 require prior authorization?

No, G44.031 does not require prior authorization (high confidence). Covered without prior authorization.

`G44.031`, Episodic paroxysmal hemicrania, 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.
Magnesium supplementation for migraine prevention in adults (limited evidence from small RCTs with mixed results; discussed as a possible option).
IV ketamine infusion combined with magnesium sulfate for chronic intractable cluster headache (case reports showing symptomatic relief; Moisset et al. 2017).
Intravenous and intranasal ketamine for acute/abortive treatment of migraine (multiple small RCTs, open-label studies and systematic reviews/meta-analyses; potential short-term analgesic benefit reported).
Inpatient continuous or multi-day ketamine or lidocaine infusion protocols as therapy for refractory chronic migraine (rCM) when other treatments have failed (practice series and pilot studies; Mojica et al. 2021; Schwenk et al. 2021; Ray et al. 2022).

AMBETTER-CP.VP.63, Visual Field Testing

AETNA-CPB-0462, Headaches: Nonsurgical Management

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.