Does G46.3 require prior authorization?

No, G46.3 does not require prior authorization (high confidence). Covered without prior authorization.

`G46.3`, Brain stem stroke syndrome

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When billing these procedures after carotid endarterectomy, include the surgery date and the phrase 'carotid endarterectomy' in the claim narrative.
When reporting a reduced (unilateral/limited) service, append modifier -52 and include an explanation of the reduced service in Item 19 of the CMS-1500 form or electronic equivalent; any appropriate supporting documentation may be submitted with the claim.
Follow Novitas LCD L35397 for the reasonable and necessary documentation requirements and frequency limitations, and consult NCCI edits for correct coding combinations prior to billing Medicare.
The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.

Non-invasive cerebrovascular arterial studies are covered when reasonable and necessary as defined by Novitas Local Coverage Determination (LCD) L35397.
Duplex post-interventional follow-up studies (typically limited and unilateral) are covered for evaluation after cerebrovascular intervention.
Vascular studies performed after carotid endarterectomy are covered when the claim includes the procedure date and the narrative 'carotid endarterectomy.'
Visual field testing is covered when billed to the Part A or Part B MAC with a valid ICD-10-CM diagnosis code that best describes the patient’s condition and when the service is reasonable and necessary.
For diagnostic visual field tests, report the test result on the claim if known; if the result is not known, report the signs or symptoms that prompted the test.
If the service requires a referring/ordering physician, include the ordering/referring physician’s name and NPI on the claim.

CGS-J15-L34394, Visual Fields Testing

J15

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

J15

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

J15

CGS-J18-L34394, Visual Fields Testing

J18

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