Does G71.02 require prior authorization?

No, G71.02 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G71.02`, Facioscapulohumeral muscular dystrophy

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

A face-to-face encounter and a Written Order Prior to Delivery (WOPD) are required for specified HCPCS codes pursuant to Final Rule 1713 and must be obtained prior to delivery per the LCD-related Standard Documentation Requirements (A55426).
For reimbursement of replacement A7020, the claim must include the diagnosis code that justifies the need for the interface.
Suppliers must follow the general documentation requirements in the LCD and the LCD-related Standard Documentation Requirements Article; refer to the related local coverage documents for full policy-specific documentation details.
Suppliers should contact the PDAC contractor for guidance on correct coding of mechanical in-exsufflation items.

Mechanical in-exsufflation devices are covered under the Durable Medical Equipment (DME) benefit when the beneficiary meets the reasonable and necessary (R&N) requirements specified in the related Local Coverage Determination (LCD).
Replacement reimbursement for HCPCS A7020 is allowed only if the beneficiary owns or is purchasing the mechanical in-exsufflation device and the claim includes the diagnosis code that justifies medical need.
Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
Occupational therapy is covered for patients with migraine (G43.xx) who require training to reduce pain during basic and instrumental activities of daily living, typically completed in 3–4 sessions.

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

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