Does G90.519 require prior authorization?

No, G90.519 does not require prior authorization (high confidence). Covered without prior authorization.

`G90.519`, Complex regional pain syndrome I of unspecified upper limb

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
Maintain complete, legible medical records for every page with patient identifiers and dates of service; records must be available to the contractor upon request.
Include the legible signature of the physician or non-physician practitioner responsible for the care and ensure the submitted record supports the selected ICD-10-CM and CPT/HCPCS codes.
Retain and provide information about the equipment used for ANS studies when requested to demonstrate compliance with equipment and procedural requirements.

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).
Report CPT 95921 when at least two parasympathetic cardiovagal tests are performed (heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio).
Report CPT 95922 when both vasomotor adrenergic components are performed: Valsalva maneuver with beat-to-beat blood pressure and R-R interval changes AND at least five minutes of passive tilt testing.
Report CPT 95924 only when both parasympathetic (cardiovagal) and vasomotor adrenergic functions are tested together and passive tilt of at least five minutes is included.
Perform QSART to evaluate integrity of distal postganglionic sympathetic sudomotor fibers in diabetic and other autonomic neuropathies or progressive autonomic disorders to determine severity and distribution of sympathetic deficit.
NC-stat testing (CPT 95905) is allowed when the beneficiary has a high pre-test or prior probability of Carpal Tunnel Syndrome (CTS), limited to one service per arm.

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

FIRST_COAST-L33609, Autonomic Function Tests

FIRST_COAST-L33933, Peripheral Nerve Blocks

A57651

Ask Backwork about documentation requirements, denial risks, or coverage in your state.