Does G96.811 require prior authorization?

No, G96.811 does not require prior authorization (high confidence). Covered without prior authorization.

`G96.811`, Intracranial hypotension, spontaneous

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

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.
Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
Tilt table testing, alone or in combination with administration of provocative agents (e.g., isoproterenol), medically necessary for the following indications when criteria are met:

AETNA-CPB-0299, Tilt Table Testing

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

A57206, Billing and Coding: Lumbar MRI

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