Does G43.D0 require prior authorization?

No, G43.D0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G43.D0` — Abdominal migraine, not intractable

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When the service is performed in a hospital inpatient or outpatient setting, use modifier -26 to indicate the professional component.
Billing and coding must adhere to the coverage indications, limitations, and medical necessity criteria described in the associated LCD L34615 Visual Fields; follow that LCD for clinical eligibility and documentation requirements.
Prior to billing Medicare, verify applicable code combinations and correct coding guidelines with the CCI (Correct Coding Initiative).
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

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).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Botulinum toxin injections are covered when medically necessary as defined by the Local Coverage Determination (LCD) 'Indications of Coverage' and when supported in the patient's medical record.

L39908 — Botulinum Toxin Injections

J05

A57483 — Billing and Coding: Visual Fields

J05

L34615 — Visual Fields

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.