Does N94.3 require prior authorization?

No, N94.3 does not require prior authorization (high confidence). Covered without prior authorization.

`N94.3`, Premenstrual tension syndrome

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.
Documentation of diagnosis: Member is diagnosed with bipolar disorder or recurrent major depression.

Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
ICD-10 codes covered if selection criteria are met: F33.0 - F33.9 Major depression disorder, recurrent [seasonal affective disorder]
When criteria are met, Aetna covers rental of the high-intensity light unit for the first month to see if home phototherapy is effective in relieving the member's depression.
CPT code covered if selection criteria are met: 96900 Actinotherapy (ultraviolet light).

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

AETNA-CPB-0512, Premenstrual Syndrome and Premenstrual Dysphoric Disorder

AETNA-CPB-0370, Phototherapy for Psychiatric Disorders

Ask Backwork about documentation requirements, denial risks, or coverage in your state.