Does G92.9 require prior authorization?

No, G92.9 does not require prior authorization (high confidence). Covered without prior authorization.

`G92.9`, Unspecified toxic encephalopathy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When the service is performed in a hospital inpatient or outpatient setting, use modifier -26 to indicate the professional component.
Billing and coding must adhere to the coverage indications, limitations, and medical necessity criteria described in the associated LCD L34615 Visual Fields; follow that LCD for clinical eligibility and documentation requirements.
Prior to billing Medicare, verify applicable code combinations and correct coding guidelines with the CCI (Correct Coding Initiative).
The plan of care should be ongoing (i.e., updated as the patient's condition changes), and treatment should demonstrate reasonable expectation of improvement.

Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
ICD-10 G92.00 - G92.9 Toxic encephalopathy (covered if selection criteria are met).
Rehabilitation for visuo-spatial deficits (generally entails 20 1-hour sessions delivered over the course of 4 weeks).

WPS-J5-L34615, Visual Fields

A57483, Billing and Coding: Visual Fields

WPS-J8-L34615, Visual Fields

AETNA-CPB-0214, Cognitive Rehabilitation

AETNA-CPB-0221, Quantitative EEG (Brain Mapping)

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