Does G40.901 require prior authorization?

No, G40.901 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G40.901` — Epilepsy, unspecified, 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.

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.
Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
Claims for drug screening services are payable under Medicare Part B only in these places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center — freestanding (50), rural health clinic — freestanding (72), and independent laboratory (81).
Ambulatory EEG is covered for diagnostic evaluation when seeking to detect clinical seizures or interictal epileptiform activity.

L34645 — Urine Drug Testing

J05

A56915 — Billing and Coding: Urine Drug Testing

J05

L33574 — Visual Fields Testing

J06

A59416 — Billing and Coding: Urine Drug Testing

J06

A56551 — Billing and Coding: Visual Fields Testing

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