Does G81.94 require prior authorization?

No, G81.94 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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`G81.94`, Hemiplegia, unspecified affecting left nondominant 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

Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.
EMG and/or nerve conduction studies are indicated for evaluation of suspected radiculopathy.
EMG and/or nerve conduction studies are indicated for evaluation of suspected mononeuropathy (single-nerve entrapment or injury).
EMG and/or nerve conduction studies are indicated for evaluation of suspected polyneuropathy or mononeuropathy multiplex.
EMG is indicated for evaluation of suspected myopathy.
EMG and nerve conduction studies are indicated for evaluation of suspected motor neuropathies (e.g., amyotrophic lateral sclerosis).

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

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

J15

CGS-J18-L34394, Visual Fields Testing

J18

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

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

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

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

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

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A59553, Billing and Coding: Trigger Point Injections

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

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

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

NGS-J6-L33574, Visual Fields Testing

A56551, Billing and Coding: Visual Fields Testing

`G81.94`, Hemiplegia, unspecified affecting left nondominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G81.94, Hemiplegia, unspecified affecting left nondominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G81.94`, Hemiplegia, unspecified affecting left nondominant side