Does G40.813 require prior authorization?

No, G40.813 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G40.813` — Lennox-Gastaut syndrome, 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.
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.
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.

A56551 — Billing and Coding: Visual Fields Testing

J06

L33399 — EEG Ambulatory Monitoring

J06

A59915 — Billing and Coding: Pharmacogenomic Testing

J06

L39995 — Pharmacogenomic Testing

J06

A59914 — Billing and Coding: Pharmacogenomic Testing

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