Does I69.242 require prior authorization?

No, I69.242 does not require prior authorization (high confidence). Covered without prior authorization.

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`I69.242`, Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting left 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.'
Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53 is reported.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.

20 Active Policies

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

A57594, Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

WPS-J5-L40381, Botulinum Toxin Injections

WPS-J5-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

WPS-J5-L39909, Botulinum Toxin Injections

NGS-J6-L39832, Botulinum Toxin Injections

WPS-J8-L39909, Botulinum Toxin Injections

WPS-J8-L40381, Botulinum Toxin Injections

WPS-J8-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

NOVITAS-JH-L35101, Psychiatric Codes

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

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

NGS-JK-L39832, Botulinum Toxin Injections

NOVITAS-JL-L35101, Psychiatric Codes

A54095, Billing and Coding: Nerve Conduction Studies and Electromyography

A57130, Billing and Coding: Psychiatric Codes

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

`I69.242`, Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting left dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I69.242, Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting left dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I69.242`, Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting left dominant side