Does I65.9 require prior authorization?

No, I65.9 does not require prior authorization (high confidence). Covered without prior authorization.

`I65.9`, Occlusion and stenosis of unspecified precerebral artery

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

Somatosensory testing is covered when medically reasonable and necessary and documented in the patient's medical record (relevant history, physical exam, and pertinent diagnostic test results).
Testing and interpretation are covered when ordered and/or furnished by qualified personnel who have documented training and experience in evoked potentials and electrodiagnostics per CMS guidance (accredited residency/fellowship, national certification, or accredited post-graduate training/AMA-AOA Category 1 CME).
The technical component may be furnished by a physical therapist with ABPTS certification without physician supervision, or by a certified technician under supervision consistent with the MPFSDB supervision level assigned to the CPT code (e.g., Level 21 for CPT 95925, 92526, 95927, 95938).
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
CPT codes 96132, 96133, 96136, 96137, 96138, and 96139 may be used for neuropsychological testing intended to diagnose or characterize neurocognitive effects of medical disorders that impinge directly or indirectly on the brain.
Neuropsychological testing is covered when testing is necessary as an aid in diagnosis and therapeutic planning and the medical record documents the necessity.

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

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