Does G51.39 require prior authorization?

No, G51.39 does not require prior authorization (high confidence). Covered without prior authorization.

`G51.39`, Clonic hemifacial spasm, unspecified

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.
All documentation must be available upon request and the medical record must support the medical necessity and frequency of treatment.
The medical record must document the critical nature of the anatomy or other circumstances necessitating stereotactic treatment, the patient's functional status including Karnofsky Performance Status, the treatment date(s), and the current treatment dose.
When requesting individual consideration at redetermination, providers must submit all relevant medical records and supporting literature, including at minimum two Phase II studies or one Phase III study for Contractor Medical Director review.

Stereotactic radiosurgery (SRS) is typically furnished as a single session; when more than one session is required, bill using stereotactic body radiation therapy (SBRT) codes instead of SRS codes.
Coverage on an individual (redetermination/appeal) basis may be considered for lesions that require a high radiation dose per fraction to avoid exposure of surrounding tissues when documentation and supporting literature are provided.
Stereotactic Radiosurgery (SRS) is indicated for primary central nervous system malignancies as a boost or salvage therapy.
SRS is indicated for primary and secondary tumors involving brain or spine parenchyma, meninges/dura, or immediately adjacent bony structures.
SRS is indicated for benign intracranial and spinal tumors (e.g., meningioma, acoustic neuroma, schwannoma, pituitary adenoma, pineocytoma, craniopharyngioma, glomus tumor, hemangioblastoma).
SRS is indicated for cranial vascular lesions such as arteriovenous malformations (AVM), cavernous malformations, and hemangiomas.

NGS-J6-L35076, Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

A56874, Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

NGS-JK-L35076, Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

A56612, Billing and Coding: CT of the Head

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