Does G40.011 require prior authorization?

No, G40.011 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G40.011` — Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical records must be maintained and available upon request, be legible, include complete patient identification and dates of service, and contain the legible signature of the physician or non‑physician practitioner responsible for care.
The submitted medical record must support the selected ICD‑10‑CM diagnosis code(s) and the CPT/HCPCS code billed must accurately describe the service performed.
When FDG PET is performed in the context of a CMS‑approved practical clinical trial using a specific protocol, the claim should be reported with modifier Q0.
When only the technical or professional component is performed, report the PET procedure with modifier TC (technical) or 26 (professional), respectively.

FDG PET (CPT 78608 / HCPCS A9552) is covered to differentiate Alzheimer's disease (AD) from frontotemporal dementia (FTD) in patients with a recent dementia diagnosis who have documented cognitive decline for at least 6 months and who meet diagnostic criteria for both AD and FTD.
FDG PET is covered for patients with mild cognitive impairment (MCI) or early dementia only when performed as part of a CMS‑approved practical clinical trial (coverage with evidence development).
FDG PET (CPT 78608) is covered for intractable seizures only when used as part of a pre‑surgical evaluation for seizure focus localization.
Ambulatory EEG is covered for diagnostic evaluation when seeking to detect clinical seizures or interictal epileptiform activity.
Ambulatory EEG is covered for pre-surgical evaluation to localize seizure onset when capture of multiple seizures is needed for surgical planning.
Ambulatory EEG is covered for routine follow-up monitoring of known seizure disorder or previously identified epileptiform activity.

A57604 — Billing and Coding: Intraoperative Neurophysiological Testing

J05

A57597 — Billing and Coding: Somatosensory Testing

J05

L34624 — Somatosensory Testing

J05

L34623 — Intraoperative Neurophysiological Testing

J05

L33399 — EEG Ambulatory Monitoring

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