Does R29.742 require prior authorization?

No, R29.742 does not require prior authorization (high confidence). Covered without prior authorization.

`R29.742`, NIHSS score 42

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.

Intra-arterial mechanical embolectomy or thrombectomy is consideredmedically necessaryin the treatment of ischemic stroke whenanyof the following criteria sets (I, II, III, IVorV) have been met:
Anterior cerebral artery (A1 or A2), middle cerebral artery (M1 or M2) or intracranial carotid artery occlusion whenallcriteria are met:Mechanical embolectomy is performed within 6 hours of onset of symptoms;andNIH Stroke Scale (NIHSS) score of 2 or greater;andNeuroimaging has ruled out intracranial hemorrhage or arterial dissection.
Mechanical embolectomy is performed within 6 hours of onset of symptoms;and
NIH Stroke Scale (NIHSS) score of 2 or greater;and
Neuroimaging has ruled out intracranial hemorrhage or arterial dissection.
Intracranial internal carotid arteryormiddle cerebral artery (M1) occlusion whenallcriteria are met:Mismatch between the severity of the clinical deficit and the infarct volume, as defined inanyof the following situations:80 years of age or older: NIHSS score of 10 or higher and an infarct volume of less than 21 ml;orLess than 80 years of age: NIHSS score of 10 or higher and an infarct volume of less than 31 ml;orLess than 80 years of age: NIHSS score of 20 or higher and an infarct volume from 3 [...]

ANTHEM-CG-SURG-115, Mechanical Embolectomy for Treatment of Stroke

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

A56612, Billing and Coding: CT of the Head

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