Does I63.89 require prior authorization?

No, I63.89 does not require prior authorization (high confidence). Code is covered without prior authorization.

`I63.89`, Other cerebral infarction

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
A permanent record of the studies performed and the interpretation must be maintained in the medical record.
The report must describe the studies performed and document any contrast media and/or radiopharmaceuticals used.
Any known significant patient reaction or complication must be recorded in the medical record.

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.
Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >60% who are asymptomatic and these patients are normally followed on an annual basis.
Repeat duplex ultrasound scans are covered at any time for patients who become symptomatic of carotid disease, without regard to scheduled surveillance intervals.
Post–carotid endarterectomy (outside the global period) duplex ultrasonography is covered on the affected (ipsilateral) side at approximately 6 weeks, 6 months, and annually thereafter unless new symptoms develop.
One preoperative Doppler scan for bypass surgery is considered reasonable and necessary and is covered.

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

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

J15

CGS-J15-L34394

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