Does G40.811 require prior authorization?

No, G40.811 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G40.811` — Lennox-Gastaut syndrome, not 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.

Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
Urine drug testing (UDT) and drugs-of-abuse testing are covered when reasonable and necessary per LCD L35006 and ordered on an individual patient basis by the treating clinician with medical-record documentation of medical necessity.
Patients with a documented diagnosis consistent with substance use disorder (SUD) may qualify for an exception to the standard presumptive UDT annual limits.
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.

L33574 — Visual Fields Testing

J06

A59914 — Billing and Coding: Pharmacogenomic Testing

J06

A57030 — Billing and Coding: EEG Ambulatory Monitoring

J06

L39995 — Pharmacogenomic Testing

J06

A56551 — Billing and Coding: Visual Fields Testing

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