Does H81.312 require prior authorization?

No, H81.312 does not require prior authorization (high confidence). Covered without prior authorization.

`H81.312`, Aural vertigo, left ear

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must include appropriate ICD-10-CM diagnosis codes and the medical record must document the diagnosis or clinical suspicion, relevant signs/symptoms, and that coverage criteria were met.
A physician's order is required for VFT performed by licensed audiologists.
Documentation must record test-specific details (e.g., number of positions tested for CPT 92542; type and laterality of irrigations for CPT 92537/92538 and any use of modifier 52; justification for CPT 92557's speech recognition component; and electrode use/serial testing for CPT 92547).
Claims and testing must comply with the Local Coverage Determination L34537 and applicable CFR supervision requirements.

Monothermal irrigation (CPT 92538) is covered when both ears are irrigated with the same temperature (cool or warm).
Vestibular diagnostic procedures (CPT 92541-92542, 92544-92548) are covered when an appropriate ICD-10-CM diagnosis or clinical suspicion for vestibular dysfunction is documented in the medical record and the test is ordered and performed by an authorized provider.
Basic audiometry (CPT 92552 or CPT 92553) is covered when ordered and performed in conjunction with vestibular function testing (VFT).
Comprehensive audiometry (CPT 92557) is covered when ordered and performed in conjunction with VFT or instead of CPT 92553 when speech recognition testing is reasonable and necessary (e.g., vestibular schwannoma).
Complete caloric vestibular testing (CPT 92537) is covered when bilateral bithermal irrigation (one warm and one cool irrigation per ear) is performed.
Vestibular function testing is covered when medically necessary to evaluate balance or suspected vestibular dysfunction and when other physiological, psychological, medication-related, or systemic causes of balance problems have been ruled out.

FIRST_COAST-L33966, Vestibular Function Tests

NOVITAS-JH-L35007, Vestibular and Audiologic Function Studies

NOVITAS-JL-L35007, Vestibular and Audiologic Function Studies

A57434, Billing and Coding: Vestibular and Audiologic Function Studies

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