Does G44.099 require prior authorization?

No, G44.099 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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`G44.099`, Other trigeminal autonomic cephalgias (TAC), not 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.

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.
Pituitary adenomas (secretory pituitary adenomas; SRS)
Trigeminal neuralgia (Gamma Knife SRS)
Medial thalamotomy/medial temporal procedures for intractable pain or epilepsy (SRS/Gamma Knife)
Spinal lesions including chordomas of spine and sacrum (high-dose single-fraction radiotherapy/SRS) and spinal arteriovenous malformations (stereotactic radiosurgery / fractionated approaches)

5 Active Policies

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

AMBETTER-CP.VP.63, Visual Field Testing

AETNA-CPB-0083, Stereotactic Radiosurgery

A56612, Billing and Coding: CT of the Head

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

`G44.099`, Other trigeminal autonomic cephalgias (TAC), not intractable

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

G44.099, Other trigeminal autonomic cephalgias (TAC), not intractable

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`G44.099`, Other trigeminal autonomic cephalgias (TAC), not intractable