Does G40.111 require prior authorization?

No, G40.111 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G40.111` — Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

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.
Bill HCPCS code G0278 for femoral or iliac angiography performed at the time of coronary angiography.
Aortography and peripheral angiography are covered when reasonable and necessary per Local Coverage Determination L36767 and when documentation supports the selected ICD-10-CM diagnosis and medical necessity.
Somatosensory testing is covered when medically reasonable and necessary and documented in the patient's medical record (relevant history, physical exam, and pertinent diagnostic test results).

L34624 — Somatosensory Testing

J05

L34623 — Intraoperative Neurophysiological Testing

J05

A57604 — Billing and Coding: Intraoperative Neurophysiological Testing

J05

A57597 — Billing and Coding: Somatosensory Testing

J05

L33399 — EEG Ambulatory Monitoring

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