Does R45.86 require prior authorization?

No, R45.86 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R45.86`, Emotional lability

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.
Pre- and post-operative neuropsychological testing (as used in studies assessing predictive value of fMRI for post-operative naming decline).

Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
fMRI lateralizes language in children with cerebral lesions.
Covered ICD-10 diagnoses when selection criteria are met: C79.31 - C79.49 (Secondary malignant neoplasm of brain and other parts of nervous system).
Aetna considers functional magnetic resonance imaging (fMRI) medically necessary to identify the eloquent cortex in pre-surgical evaluation of persons with brain tumors (except temporal tumors), epilepsy (except temporal neocortical epilepsy), or vascular malformations.

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

AETNA-CPB-0739, Quantitative, Functional and Connectomic Analysis of Brain MRI

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