Does G97.49 require prior authorization?

No, G97.49 does not require prior authorization (high confidence). Covered without prior authorization.

`G97.49`, Accidental puncture and laceration of other nervous system organ or structure during other procedure

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When billing these procedures after carotid endarterectomy, include the surgery date and the phrase 'carotid endarterectomy' in the claim narrative.
When reporting a reduced (unilateral/limited) service, append modifier -52 and include an explanation of the reduced service in Item 19 of the CMS-1500 form or electronic equivalent; any appropriate supporting documentation may be submitted with the claim.
Follow Novitas LCD L35397 for the reasonable and necessary documentation requirements and frequency limitations, and consult NCCI edits for correct coding combinations prior to billing Medicare.

Non-invasive cerebrovascular arterial studies are covered when reasonable and necessary as defined by Novitas Local Coverage Determination (LCD) L35397.
Duplex post-interventional follow-up studies (typically limited and unilateral) are covered for evaluation after cerebrovascular intervention.
Vascular studies performed after carotid endarterectomy are covered when the claim includes the procedure date and the narrative 'carotid endarterectomy.'
Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

WPS-J8-L35753, Non-Invasive Cerebrovascular Studies

FIRST_COAST-L33977, Transcranial Doppler Studies

NOVITAS-JH-L35397, Non-Invasive Cerebrovascular Arterial Studies

A52992, Billing and Coding: Non-Invasive Cerebrovascular Arterial Studies

NOVITAS-JL-L35397, Non-Invasive Cerebrovascular Arterial Studies

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A56697, Billing and Coding: Non-Invasive Vascular Studies

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

A57633, Billing and Coding: Transcranial Doppler Studies