Does I63.12 require prior authorization?

No, I63.12 does not require prior authorization (high confidence). Covered without prior authorization.

`I63.12`, Cerebral infarction due to embolism of basilar artery

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Progress notes must document medical necessity for the EKG monitoring service.
List the diagnosis code(s) indicating the reason for the test on the claim.
The physician interpreting the test must be identified on the claim form with his/her sequence number in Box 24K.
If an IDTF bills the total component, the physician's name and address must be on file with the WPS Provider Enrollment Department and the physician must provide a letter assigning monies collected for professional codes to the IDTF.

Holter monitoring (CPT 93224-93227) is covered for up to 48 hours of continuous recording when progress notes document medical necessity.
Wearable external mobile cardiac telemetry (CPT 93228 professional, 93229 technical) is covered as one unit per course of treatment that includes up to 30 consecutive days of cardiac monitoring when the documented services (hook-up, transmission, analysis, daily reports, equipment and supplies, and physician review) are provided.
Long-term continuous recorders (CPT 93241-93248) that continuously record and store for greater than 48 hours up to 7 days, or greater than 7 days up to 15 days, are covered in the outpatient setting when documentation supports medical necessity.
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).

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.