Does I63.49 require prior authorization?

No, I63.49 does not require prior authorization (high confidence). Covered without prior authorization.

`I63.49`, Cerebral infarction due to embolism of other cerebral 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.
TEE is covered when transthoracic echocardiography (TTE) is technically inadequate or does not provide sufficient data for definitive therapeutic decision-making.
Doppler/color flow-velocity mapping with echocardiography is covered when it will contribute significant diagnostic information for evaluation of murmurs, valvular disease, shunts, suspected congenital heart disease, post-MI complications, or cardiomyopathy.
TEE is indicated to assess the etiology of mitral regurgitation or when needed to assist decision-making between mitral valve repair versus replacement.

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

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

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L35906

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