Does I66.01 require prior authorization?

No, I66.01 does not require prior authorization (high confidence). Covered without prior authorization.

`I66.01`, Occlusion and stenosis of right middle cerebral artery

ICD-10-CM

No Prior Auth Required

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).
A permanent record of the studies performed and the interpretation must be maintained in the medical record.

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-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L34338

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