Does G47.12 require prior authorization?

No, G47.12 does not require prior authorization (high confidence). Covered without prior authorization.

`G47.12`, Idiopathic hypersomnia without long sleep time

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.
If a sleep study is performed for less than six hours, bill with modifier 52 and report the appropriately reduced original charge.

CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
Diagnostic polysomnography or other sleep testing is covered when the patient has symptoms or complaints of one of the conditions listed in LCD L36839.
A single polysomnogram (PSG) with EEG is ordinarily sufficient and covered to evaluate and diagnose suspected obstructive sleep apnea (OSA).
Diagnosis of narcolepsy is ordinarily confirmed by up to three Multiple Sleep Latency Test (MSLT) naps; MSLT (CPT 95805) performed appropriately is covered for this indication.
Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.

CGS-J15-L36902, Polysomnography and Other Sleep Studies

J15

CGS-J18-L36902, Polysomnography and Other Sleep Studies

J18

WPS-J5-L38528, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

WPS-J5-L36839, Polysomnography and Other Sleep Studies

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