Does R68.84 require prior authorization?

No, R68.84 does not require prior authorization (high confidence). Covered without prior authorization.

`R68.84`, Jaw pain

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must be maintained and available upon request; every page must be legible and include patient identification (e.g., full name, dates of service) and identify the physician or non-physician practitioner responsible for care.
Submitted medical records must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
Billing and coding guidance in this policy complements and references Local Coverage Determination L34425; claims should be supported per the documentation requirements specified in LCD L34425.

Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Stress testing (exercise or pharmacological, including stress echocardiography) is covered when the results will potentially affect the patient’s treatment plan.
An initial follow-up stress test may be indicated several months after myocardial infarction (MI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) when clinically appropriate.

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

A56034, Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

A56607, Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)

A56729, Billing and Coding: Magnetic Resonance Imaging of the Head and Neck

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