Does P91.819 require prior authorization?

No, P91.819 does not require prior authorization (high confidence). Covered without prior authorization.

`P91.819`, Neonatal encephalopathy, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Covered ICD-10 diagnosis codes if selection criteria are met: E74.4 (disorders of pyruvate metabolism and gluconeogenesis).
Covered ICD-10 diagnosis codes if selection criteria are met: E88.09 (glucose transporter protein type 1 deficiency).
Covered ICD-10 diagnosis codes if selection criteria are met: Epilepsy and recurrent seizures, without status epilepticus (e.g., G40.009, G40.019, G40.109, G40.119, G40.209, G40.219, G40.309, G40.319, G40.A09, G40.A19, G40.B09, G40.B19, G40.409, G40.419, G40.509, G40.802, G40.804, G40.822, G40.824, G40.909, G40.919).
Covered ICD-10 diagnosis codes if selection criteria are met: Lennox-Gastaut syndrome (G40.811 - G40.814).

AETNA-CPB-0221, Quantitative EEG (Brain Mapping)

AETNA-CPB-0226, Hospitalization for the Initiation of Ketogenic Diet

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

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