Does G90.513 require prior authorization?

No, G90.513 does not require prior authorization (high confidence). Covered without prior authorization.

`G90.513`, Complex regional pain syndrome I of upper limb, bilateral

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Medical records maintained by the performing provider must clearly support medical necessity and include test reports and the interpreting provider's interpretation.
Supporting documentation should include relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures used to rule out more common causes of autonomic signs or symptoms.
For diagnostic tests report the test result if known; if results are not available, report the symptoms that prompted performance of the test.

Autonomic function testing is covered to confirm or exclude a specific autonomic nervous system disorder when medically necessary.
Repeat autonomic testing for patients with a diagnosed autonomic disorder is covered when there is a documented change in clinical status or a response to a therapeutic intervention.
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.
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.

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L35124, Autonomic Function Testing

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

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