Does G45.0 require prior authorization?

No, G45.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

Backwork Sign up free

`G45.0`, Vertebro-basilar artery syndrome

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Progress notes must document medical necessity for the EKG monitoring service.
List the diagnosis code(s) indicating the reason for the test on the claim.
The physician interpreting the test must be identified on the claim form with his/her sequence number in Box 24K.
If an IDTF bills the total component, the physician's name and address must be on file with the WPS Provider Enrollment Department and the physician must provide a letter assigning monies collected for professional codes to the IDTF.

Key Coverage Criteria

Holter monitoring (CPT 93224-93227) is covered for up to 48 hours of continuous recording when progress notes document medical necessity.
Wearable external mobile cardiac telemetry (CPT 93228 professional, 93229 technical) is covered as one unit per course of treatment that includes up to 30 consecutive days of cardiac monitoring when the documented services (hook-up, transmission, analysis, daily reports, equipment and supplies, and physician review) are provided.
Long-term continuous recorders (CPT 93241-93248) that continuously record and store for greater than 48 hours up to 7 days, or greater than 7 days up to 15 days, are covered in the outpatient setting when documentation supports medical necessity.
Non-invasive vascular studies are medically necessary when the ordering physician reasonably expects the test outcome will impact clinical management and there are significant signs or symptoms of arterial or venous disease, the information is necessary for medical/surgical management, and the test is not redundant of other diagnostics.
Cerebrovascular arterial studies (duplex or Doppler with spectral analysis) are indicated for patients with one or more of: cervical bruit, amaurosis fugax, focal cerebral/ocular TIA (e.g., unilateral weakness, sensory loss, slurred speech), syncope suggestive of vertebrobasilar/bilateral carotid disease, recent neurologic/cerebrovascular event, pre-major cardiac/vascular surgery with bruit or prior event, post-carotid endarterectomy (outside global period), pulsatile neck mass, blunt/penetratin [...]
Transcranial Doppler (TCD) is indicated to detect/evaluate severe extracranial stenosis (>=60% diameter reduction) or major basal intracranial artery stenosis (>=50% diameter reduction), cerebral vasospasm after subarachnoid hemorrhage, intracranial hemodynamic abnormalities in suspected brain death, intraoperative/perioperative monitoring during carotid endarterectomy, evaluation of cerebral embolization, assessment of collateral circulation in severe stenosis/occlusion when needed for care, st [...]

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L40243, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L40244

Have a follow-up question?

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

Ask Backwork about G45.0 Sign up free

G45.0, Vertebro-basilar artery syndrome