Does I69.851 require prior authorization?

No, I69.851 does not require prior authorization (high confidence). Covered without prior authorization.

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`I69.851`, Hemiplegia and hemiparesis following other cerebrovascular disease affecting right 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.'
CPT 97032 (attended/manual electrical stimulation) is covered when delivered with direct 1-on-1 contact by qualified personnel (examples: direct motor point stimulation; FES/NMES when performed with therapeutic exercise, neuromuscular reeducation, or functional activities).
CPT 97032 may be billed for the application, instruction, and adjustment of a TENS unit or other probe-based stimulation (including determining trigger points) when provided as an attended/manual modality.
Non-implantable pelvic floor electrical stimulation (97032 for probes; G0283 for electrode-based delivery) is covered for treatment of 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.

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-L39909, Botulinum Toxin Injections

WPS-J8-L40381, Botulinum Toxin Injections

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

A57123, Billing and Coding: 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

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

A53064, Billing and Coding: Outpatient Occupational Therapy

`I69.851`, Hemiplegia and hemiparesis following other cerebrovascular disease affecting right dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I69.851, Hemiplegia and hemiparesis following other cerebrovascular disease affecting right dominant side

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I69.851`, Hemiplegia and hemiparesis following other cerebrovascular disease affecting right dominant side