Does G89.22 require prior authorization?

No, G89.22 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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`G89.22`, Chronic post-thoracotomy 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

To bill for these (denied) procedures, providers must report CPT code 64999 for both trial and permanent electrode-array insertions and indicate whether the procedure is a trial or permanent in the claim narrative/comment field adjacent to CPT 64999.
For Part B claims enter 1 unit of service (UOS) and include the text 'Peripheral Nerve Field Stimulation', 'PNFS', 'Peripheral Subcutaneous Field Stimulation', or 'PSFS' adjacent to CPT 64999 and whether the procedure is permanent or trial in the comment/narrative field (e.g., Loop 2400 or SV101-7 for 5010A1 837P; Item 19 for paper claims).
For Part A claims enter 1 UOS and include the text 'Peripheral Nerve Field Stimulation', 'PNFS', 'Peripheral Subcutaneous Field Stimulation', or 'PSFS' adjacent to CPT 64999 and whether the procedure is permanent or trial in the comment/narrative field (e.g., Line SV02-7 for 837I electronic claims; Block 80 on the UB-04 form).

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).
Compounded medications for use in implantable infusion pumps may be covered by Medicare when their use meets all other criteria for services provided incident to a physician's service.
True off-the-shelf (non‑compounded) drugs used without compounding and administered via DME may be billed using the drug-specific HCPCS code and are reimbursed under CMS ASP methodology.
If Prialt® is implanted as a single agent in the pump, bill using HCPCS code J2278-KD.
Compounded single-agent or combination drug formulations used in implanted infusion pumps must be billed using HCPCS code J7999-KD for reimbursement.

12 Active Policies

A59553, Billing and Coding: Trigger Point Injections

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

A56034, Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

A56607, Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)

A56612, Billing and Coding: CT of the Head

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G89.22, Chronic post-thoracotomy pain