Does Q38.1 require prior authorization?

No, Q38.1 does not require prior authorization (high confidence). Covered without prior authorization.

`Q38.1`, Ankyloglossia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

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.

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

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

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

A56868, Billing and Coding: Outpatient Speech Language Pathology

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