Does I69.133 require prior authorization?

No, I69.133 does not require prior authorization (high confidence). Covered without prior authorization.

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`I69.133`, Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting right non-dominant side

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When billing these procedures after carotid endarterectomy, include the surgery date and the phrase 'carotid endarterectomy' in the claim narrative.
When reporting a reduced (unilateral/limited) service, append modifier -52 and include an explanation of the reduced service in Item 19 of the CMS-1500 form or electronic equivalent; any appropriate supporting documentation may be submitted with the claim.
Follow Novitas LCD L35397 for the reasonable and necessary documentation requirements and frequency limitations, and consult NCCI edits for correct coding combinations prior to billing Medicare.

Key Coverage Criteria

Non-invasive cerebrovascular arterial studies are covered when reasonable and necessary as defined by Novitas Local Coverage Determination (LCD) L35397.
Duplex post-interventional follow-up studies (typically limited and unilateral) are covered for evaluation after cerebrovascular intervention.
Vascular studies performed after carotid endarterectomy are covered when the claim includes the procedure date and the narrative 'carotid endarterectomy.'
Attended/manual electrical stimulation (CPT 97032) is covered when the qualified professional provides direct 1-on-1 patient contact to apply/manualy adjust stimulation (e.g., direct motor point stimulation, FES/NMES when combined with therapeutic exercise/neuromuscular reeducation/functional activities).
Non-implantable pelvic floor electrical stimulation delivered via vaginal or anal probes (reportable as CPT 97032) is covered for stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
Unattended/supervised electrical stimulation provided as part of a therapy plan of care (HCPCS G0283) is covered for non-wound indications (e.g., TENS, IFC, cyclical muscle stimulation) when used to control pain and/or swelling and when objective/subjective improvement is documented.

20 Active Policies

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

WPS-J5-L39909, Botulinum Toxin Injections

WPS-J5-L40381, Botulinum Toxin Injections

NGS-J6-L39832, Botulinum Toxin Injections

WPS-J8-L40381, Botulinum Toxin Injections

WPS-J8-L39909, Botulinum Toxin Injections

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

NOVITAS-JH-L35397, Non-Invasive Cerebrovascular Arterial Studies

NOVITAS-JH-L35101, Psychiatric Codes

NGS-JK-L39832, Botulinum Toxin Injections

A52992, Billing and Coding: Non-Invasive Cerebrovascular Arterial Studies

NOVITAS-JL-L35081, Nerve Conduction Studies and Electromyography

NOVITAS-JL-L35101, Psychiatric Codes

NOVITAS-JL-L35397, Non-Invasive Cerebrovascular Arterial Studies

A54095, Billing and Coding: Nerve Conduction Studies and Electromyography

A57130, Billing and Coding: Psychiatric Codes

A53065, Billing and Coding: Outpatient Physical Therapy

`I69.133`, Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting right non-dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I69.133, Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting right non-dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I69.133`, Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting right non-dominant side