Does I69.923 require prior authorization?

No, I69.923 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`I69.923`, Fluency disorder following unspecified cerebrovascular disease

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

When billing with a Z-code as the diagnosis, document the orthotic/prosthetic device name, date the patient received the device, and the date training/teaching began (if applicable).
Document actual SLP patient contact time in 15-minute increments and link units billed to the clinical notes showing time and skilled service provided.
For SGD services billed with CPT 92607 or 92609, retain documentation supporting selection/prescription, adaptation, and training provided to the patient.

If performing a re-evaluation, document clinical rationale and use the applicable evaluation CPT code with supporting clinical findings since no separate SLP re-evaluation CPT exists.

Maintain all documentation in the patient’s medical record; every page must be legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.

Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.

Key Coverage Criteria

Home health speech-language pathology services must be billed using HCPCS G0153 (Speech-Language Pathology).
When treating memory disturbances not associated with mental disorders (e.g., post cerebrovascular accident), use ICD-10 R68.89 as the diagnosis code for the related LCD.
Use CPT 92607 for selection and prescription of speech-generating devices (SGDs) and CPT 92609 for SGD adaptation and training.
Use CPT 92507 for speech/hearing treatment services (treatment code).
For re-evaluation in speech-language pathology, use the appropriate evaluation CPT code because CPT does not define a separate SLP re-evaluation code.
Speech-language pathology (SLP) services for treatment or evaluation of communication disorders when determined reasonable and necessary per LCD L35070.

11 Active Policies

NOVITAS-JH-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

NOVITAS-JH-L35101, Psychiatric Codes

A54111, Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

NOVITAS-JL-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

A53052, Billing and Coding: Home Health Speech-Language Pathology

A56612, Billing and Coding: CT of the Head

A56868, Billing and Coding: Outpatient Speech Language Pathology

ANTHEM-DME.00030, Altered Auditory Feedback Devices for Fluency Disorders

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I69.923, Fluency disorder following unspecified cerebrovascular disease