B10.09 — Other human herpesvirus encephalitis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For claims using CPT codes not listed in this article, submit supporting clinical and billing documentation for individual review.
- A claim for the prior routine EEG must have been submitted to Medicare with a date of service within 1 year of the ambulatory EEG date of service; documentation/proof of that prior claim must be available.
- When billing only the professional or the technical component, documentation must indicate which component was provided and support billing of that single component.
- Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Key Coverage Criteria
- Ambulatory continuous EEG is covered only if a prior routine “resting” EEG was performed before the ambulatory EEG.
- Routine EEGs covered under this policy are those described by CPT codes 95812, 95813, 95816, 95819, or 95822.
- A routine EEG is defined as a recording of less than a 24-hour continuous duration.
- 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.
- G71.21 | Nemaline myopathy
7 Active Policies
A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck
AETNA-CPB-0650 — Polymerase Chain Reaction Testing: Selected Indications
A56771 — Billing and Coding: Special Electroencephalography
A57204 — Billing and Coding: MRI and CT Scans of the Head and Neck
L33447 — Special Electroencephalography
Related Codes
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