Does R94.01 require prior authorization?

No, R94.01 does not require prior authorization (high confidence). Covered without prior authorization.

`R94.01`, Abnormal electroencephalogram [EEG]

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.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Attended electroencephalographic (EEG) video monitoring performed in a healthcare facility is medically necessary when the diagnosis remains uncertain after recent (within the past 90 days) neurological examinations and standard EEG studies, and non-neurological causes of symptoms (e.g., syncope, cardiac arrhythmias) have been ruled out, for any of the following:
To differentiate epileptic events from psychogenic seizures (conversion disorder with seizures or convulsions).
To establish the first diagnosis of a seizure disorder (epilepsy and recurrent seizures - ICD-10 G40.001–G40.919).
To establish the specific type of epilepsy in poorly characterized seizure types when such characterization is medically necessary to select the most appropriate therapeutic regimen (including absence and juvenile myoclonic epilepsy - ICD-10 G40.A01–G40.B19).

ANTHEM-CG-LAB-20, Thyroid Testing

CIGNA-0521, Electroencephalography

AETNA-CPB-0322, Attended Electroencephalographic (EEG) Video Monitoring

A56612, Billing and Coding: CT of the Head

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

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