Does G81.91 require prior authorization?

No, G81.91 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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`G81.91`, Hemiplegia, unspecified affecting right dominant side

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

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.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.

Key Coverage Criteria

MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).
MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair when it is comparable to CA for determining extent of AAA and evaluating aortoiliac occlusive disease and renal artery pathology necessary for surgical planning.
MRA of the renal arteries and aortoiliac arteries (in the absence of AAA or aortic dissection) is covered when MRA is expected to avoid CA, physician history/physical and standard assessments are insufficient, and obtaining MRA has a high probability of positively affecting patient management.
MRA of the chest is covered for diagnosis of suspected pulmonary embolism when the patient has a contraindication to receiving intravascular iodinated contrast material.
MRA of the chest is covered for pre-operative and post-operative evaluation of thoracic aortic dissection and thoracic aortic aneurysm and may be used as an alternative to other non-invasive imaging when clinically appropriate.

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L38694, Computed Tomography Cerebral Perfusion Analysis (CTP)

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J18-L38694, Computed Tomography Cerebral Perfusion Analysis (CTP)

J18

CGS-J18-L34394, Visual Fields Testing

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

WPS-J5-L35486, Pelvic Floor Dysfunction: Anorectal Manometry and EMG

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

A59553, Billing and Coding: Trigger Point Injections

A57595, Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

A56551, Billing and Coding: Visual Fields Testing

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

NGS-J6-L38667, Computed Tomography Cerebral Perfusion Analysis (CTP)

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

NGS-J6-L33574, Visual Fields Testing

`G81.91`, Hemiplegia, unspecified affecting right dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G81.91, Hemiplegia, unspecified affecting right dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G81.91`, Hemiplegia, unspecified affecting right dominant side