Does G45.9 require prior authorization?

No, G45.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G45.9`, Transient cerebral ischemic attack, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.

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 cerebrovascular/vascular studies are covered when the study results will be used to directly inform or change the clinical management of the patient.
Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >50% who are symptomatic and these patients are normally followed on an annual basis.
Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >60% who are asymptomatic and these patients are normally followed on an annual basis.

CGS-J15-L34084, Transcatheter Infusion Therapy

J15

CGS-J15-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

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