Does G44.201 require prior authorization?

No, G44.201 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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`G44.201`, Tension-type headache, 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.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., name, dates of service), and be made available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for the care and signed/dated office visit or operative report.

Key Coverage Criteria

Trigger point injections (CPT 20552 or 20553) are covered when medically necessary to treat documented myofascial trigger points causing pain, with procedural documentation supporting medical necessity.
CPT 20552 may be reported for trigger point injections involving 1 or 2 muscles; CPT 20553 may be reported for injections involving 3 or more muscles.
The medication used for the injection must be billed on the same claim as the trigger point administration and reported with the appropriate HCPCS drug J-code or revenue code.
Trigger point injections (CPT 20552, 20553) are covered when they meet the reasonable and necessary clinical requirements and frequency limitations of the referenced LCD L39656.
Trigger point injections (TPIs) reported with CPT 20552 (1–2 muscles) or CPT 20553 (3+ muscles) are covered when determined medically reasonable and necessary per the applicable Local Coverage Determination (LCD).
Only services that meet the LCD reasonable and necessary requirements and frequency limitations are considered covered; billing of TPIs must follow CPT coding guidance in the AMA CPT manual.

16 Active Policies

CGS-J15-L39656, Trigger Point Injections (TPI)

J15

CGS-J18-L39656, Trigger Point Injections (TPI)

J18

A59553, Billing and Coding: Trigger Point Injections

WPS-J5-L39713, Trigger Point Injections

NGS-J6-L39662, Trigger Point Injections (TPI)

A59487, Billing and Coding: Trigger Point Injections (TPI)

WPS-J8-L39713, Trigger Point Injections

NGS-JK-L39662, Trigger Point Injections (TPI)

A57701, Billing and Coding: Trigger Point Injections (TPI)

A59480, Billing and Coding: Trigger Point Injections (TPI)

A59498, Billing and Coding: Trigger Point Injections (TPI)

ANTHEM-CG-MED-97, Biofeedback and Neurofeedback

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

ANTHEM-CG-SURG-17, Trigger Point Injections

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

A56612, Billing and Coding: CT of the Head

`G44.201`, Tension-type headache, unspecified, intractable

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

G44.201, Tension-type headache, unspecified, intractable

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

`G44.201`, Tension-type headache, unspecified, intractable