Does G43.401 require prior authorization?

No, G43.401 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G43.401` — Hemiplegic migraine, not intractable, with status migrainosus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (for example, full name and dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Magnetic resonance angiography (MRA) is covered only when the service meets the reasonable and necessary coverage criteria specified in Local Coverage Determination L34865.
Billing and coding for Category III codes is allowed only when the service meets the coverage indications, limitations, and medical necessity criteria described in LCD L35490 and the performing physician (MD/DO) meets all criteria in that LCD and this Billing and Coding Article.
CPT 0446T, 0447T, and 0448T (creation/removal/replacement of implantable interstitial glucose sensor) are billed and covered only per LCD L38686 and Billing and Coding Article A58213 when all criteria in that LCD/article are met.
CPT 0421T and HCPCS C2596 (transurethral waterjet ablation of the prostate and associated probe) are billed and covered only per LCD L38682 and Billing and Coding Article A58209 when all criteria in that LCD/article are met.
Electrocardiographic (EKG/ECG) monitoring (Holter or real-time) billing and coverage follow LCD L34636 and Billing and Coding Article A57476 and are allowed when those LCD/article criteria are met.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.

L35490 — Category III Codes

J05

A57483 — Billing and Coding: Visual Fields

J05

A56902 — Billing and Coding: Category III Codes

J05

L38839 — Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease

J05

L38682 — Transurethral Waterjet Ablation of the Prostate

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