Does G56.91 require prior authorization?

No, G56.91 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`G56.91`, Unspecified mononeuropathy of right upper limb

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

When NCSs and NEMG are performed on the same day for the same patient they must be reported on the same claim.
When billing non-covered services/tests report unlisted neurological CPT 95999 and provide a description of the service/test in block 80 (Part A) or box 19 (Part B) or electronic equivalent; failure to include this information will result in Part A claims being returned and Part B claims rejected.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.

Key Coverage Criteria

Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53 is reported.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
Automated nerve conduction testing using the NC-stat (CPT 95905) is allowed only when there is a high pre-test or prior probability of carpal tunnel syndrome and the claim uses diagnosis code G56.01 or G56.02; allowed one service per arm.

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L34616, Psychiatry and Psychology Services

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A57480, Billing and Coding: Psychiatry and Psychology Services

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

WPS-J8-L34616, Psychiatry and Psychology Services

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

NOVITAS-JL-L35081, Nerve Conduction Studies and Electromyography

A54095, Billing and Coding: Nerve Conduction Studies and Electromyography

A56607, Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A56731, Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathy

A56034, Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

`G56.91`, Unspecified mononeuropathy of right upper limb

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G56.91, Unspecified mononeuropathy of right upper limb

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G56.91`, Unspecified mononeuropathy of right upper limb