Does G89.18 require prior authorization?

No, G89.18 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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`G89.18`, Other acute postprocedural pain

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

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.
The performing provider must maintain medical record documentation that clearly supports the medical necessity of the billed service and include that documentation in the patient's record for review upon request.
Documentation should state whether the block was diagnostic or therapeutic, include pre- and post-procedure evaluations, and document patient education and the assessment of procedural outcome.
Documentation must support coverage criteria in the LCD 'Indications and Limitations of Coverage and/or Medical Necessity' section and the provider should document why services cannot be rendered by the surgeon when applicable.

Key Coverage Criteria

CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
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.
Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.

20 Active Policies

A59553, Billing and Coding: Trigger Point Injections

NGS-J6-L39995, Pharmacogenomic Testing

A57452, Billing and Coding: Peripheral Nerve Blocks

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

NGS-J6-L36850

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G89.18, Other acute postprocedural pain