Does G43.511 require prior authorization?

No, G43.511 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G43.511` — Persistent migraine aura without cerebral infarction, intractable, with status migrainosus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For claims requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
The medical record must include the ordering provider's assessment related to the visit, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report.
For botulinum toxin coverage, medical records must document medical necessity for treatment.
For spastic conditions other than upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia or other focal dystonias, documentation must state the condition was unresponsive to conventional treatment and include the covered diagnosis, dosages, injection sites, frequencies, EMG necessity if used, and description of treatment effectiveness.

Medicare covers botulinum toxin injections for medically necessary treatment of spastic conditions including upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia, and other focal dystonias.
Medicare will reimburse unused portions of reconstituted botulinum toxin when the medical record documents the precise amount administered and the amount discarded.
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.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).

L34615 — Visual Fields

J05

A57483 — Billing and Coding: Visual Fields

J05

L39908 — Botulinum Toxin Injections

J05

A59808 — Billing and Coding: Botulinum Toxin Injections

J05

A59706 — Billing and Coding: Botulinum Toxin Injections

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