Does I63.09 require prior authorization?

No, I63.09 does not require prior authorization (high confidence). Code is covered without prior authorization.

`I63.09`, Cerebral infarction due to thrombosis of other precerebral artery

ICD-10-CM

No Prior Auth Required

Code is 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).
Follow the Local Coverage Determination MolDX: Biomarkers in Cardiovascular Risk Assessment (L36523) for required documentation, medical necessity criteria, and claim submission instructions; this article provides supplemental billing and coding guidance only.

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).
Non-invasive cerebrovascular/vascular studies are covered when the study results will be used to directly inform or change the clinical management of the patient.
Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >50% who are symptomatic and these patients are normally followed on an annual basis.

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J15

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