Does 91122 require prior authorization?

No, 91122 does not require prior authorization (high confidence). Code is covered without prior authorization.

`91122`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical record must contain a complete history including duration and characteristics of urinary or fecal incontinence, frequency, timing and amount of continent voids and incontinent episodes, precipitants of incontinence, other urinary symptoms, bowel habits, daily fluid intake, sexual function alterations due to incontinence, amount and type of perineal pads/protective devices, and prior treatments with their effects.
Medical record must include a neurological exam and a physical exam guided by history: pelvic exam in women (skin condition, genital atrophy, pelvic organ prolapse, pelvic masses, paravaginal muscle tone), abdominal exam, genital exam in men, rectal exam (perineal sensation, resting/active sphincter tone, fecal impaction, masses) and in men prostate consistency/contour; include past surgeries and pregnancy history in females.
Billing and coding must reflect the coverage indications, limitations, and medical necessity as described in the related LCD; documentation must support the chosen diagnostic CPT codes.

Anorectal manometry and pelvic floor electromyography (EMG) are indicated as diagnostic tests for evaluation of anorectal or pelvic floor dysfunction (e.g., fecal incontinence or anorectal neuromuscular disorders).
Testing may be performed when documentation in the medical record supports medical necessity per the related Local Coverage Determination (LCD).
An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.
A supervising physician for an IDTF must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, meet proficiency standards for tests supervised, and provide general supervision for no more than three IDTF sites.
An interpreting physician must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, and qualified to interpret the types of tests (codes) listed on the IDTF enrollment application.

A57595 — Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG

J05

L35486 — Pelvic Floor Dysfunction: Anorectal Manometry and EMG

J05

L33693 — Peripheral Venous Ultrasound

J09

L37371 — Electroretinography (ERG)

J12

A53252

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