Does G89.11 require prior authorization?

No, G89.11 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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`G89.11`, Acute pain due to trauma

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

Medical records must be maintained and available upon request; every page must be legible and include patient identification (e.g., full name, dates of service) and identify the physician or non-physician practitioner responsible for care.
Submitted medical records must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
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.

Key Coverage Criteria

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).
Trigger point injections (CPT 20552 or 20553) are covered when medically necessary to treat documented myofascial trigger points causing pain, with procedural documentation supporting medical necessity.
CPT 20552 may be reported for trigger point injections involving 1 or 2 muscles; CPT 20553 may be reported for injections involving 3 or more muscles.
The medication used for the injection must be billed on the same claim as the trigger point administration and reported with the appropriate HCPCS drug J-code or revenue code.
Pharmacogenomics (PGx) testing is covered when it is reasonable and necessary per LCD L39063 and Medicare coverage rules for the beneficiary's clinical indication.

20 Active Policies

A59553, Billing and Coding: Trigger Point Injections

A59915, Billing and Coding: Pharmacogenomic Testing

A59487, Billing and Coding: Trigger Point Injections (TPI)

NGS-J6-L39995, Pharmacogenomic Testing

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G89.11, Acute pain due to trauma