Does P91.821 require prior authorization?

No, P91.821 does not require prior authorization (high confidence). Covered without prior authorization.

`P91.821`, Neonatal cerebral infarction, right side of brain

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.
Assessment of idiopathic venous thrombo-embolism, recurrent venous thrombo-embolism, thrombosis occurring at a young age (i.e., less than 45 years of age), or thrombosis at an unusual site.
CPT code 83090 (Homocysteine) — covered if selection criteria are met.
ICD-10: D51.0 - D51.9 (Vitamin B12 deficiency anemia) — covered when selection criteria are met.
ICD-10: D81.818 (Other biotin-dependent carboxylase deficiency) — covered when selection criteria are met.

AETNA-CPB-0763, Homocysteine Testing

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.