Does G93.81 require prior authorization?

No, G93.81 does not require prior authorization (high confidence). Covered without prior authorization.

`G93.81`, Temporal sclerosis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Transcranial Doppler (TCD) studies are covered only when the service meets all clinical indications and limitations specified in Local Coverage Determination L33977 and all applicable CMS national coverage, payment rules, and general medical necessity requirements.
fMRI lateralizes language in children with cerebral lesions.
Covered ICD-10 diagnoses when selection criteria are met: C79.31 - C79.49 (Secondary malignant neoplasm of brain and other parts of nervous system).
Aetna considers functional magnetic resonance imaging (fMRI) medically necessary to identify the eloquent cortex in pre-surgical evaluation of persons with brain tumors (except temporal tumors), epilepsy (except temporal neocortical epilepsy), or vascular malformations.

FIRST_COAST-L33977, Transcranial Doppler Studies

AETNA-CPB-0739, Quantitative, Functional and Connectomic Analysis of Brain MRI

A56612, Billing and Coding: CT of the Head

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

A57633, Billing and Coding: Transcranial Doppler Studies

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