Does R25.8 require prior authorization?

No, R25.8 does not require prior authorization (high confidence). Covered without prior authorization.

`R25.8`, Other abnormal involuntary movements

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
For diagnostic tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
Written documentation supporting each additional 24 hours of monitoring beyond 72 hours must be made available to Medicare upon request.

Ambulatory EEG is covered for diagnostic evaluation when seeking to detect clinical seizures or interictal epileptiform activity.
Ambulatory EEG is covered for pre-surgical evaluation to localize seizure onset when capture of multiple seizures is needed for surgical planning.
Ambulatory EEG is covered for routine follow-up monitoring of known seizure disorder or previously identified epileptiform activity.
Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L39856, Botulinum Toxin Injections

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L39856, Botulinum Toxin Injections

J18

WPS-J5-L34594

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