Does I69.351 require prior authorization?

No, I69.351 does not require prior authorization (high confidence). Covered without prior authorization.

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`I69.351`, Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s), the submitted CPT/HCPCS code must describe the service performed, and the record must clearly document medical necessity, the indication for ordering the test, and a clear diagnostic impression.

Key Coverage Criteria

Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: 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.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
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.

20 Active Policies

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J15-L38694, Computed Tomography Cerebral Perfusion Analysis (CTP)

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

CGS-J18-L38694, Computed Tomography Cerebral Perfusion Analysis (CTP)

J18

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

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

WPS-J5-L39909, Botulinum Toxin Injections

WPS-J5-L40381, Botulinum Toxin Injections

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

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

NGS-J6-L39832, Botulinum Toxin Injections

A58152, Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP)

NGS-J6-L38667, Computed Tomography Cerebral Perfusion Analysis (CTP)

WPS-J8-L40381, Botulinum Toxin Injections

WPS-J8-L35753, Non-Invasive Cerebrovascular Studies

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

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

`I69.351`, Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I69.351, Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I69.351`, Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side