G44.029 — Chronic cluster headache, not intractable
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- To bill for these (denied) procedures, providers must report CPT code 64999 for both trial and permanent electrode-array insertions and indicate whether the procedure is a trial or permanent in the claim narrative/comment field adjacent to CPT 64999.
- For Part B claims enter 1 unit of service (UOS) and include the text 'Peripheral Nerve Field Stimulation', 'PNFS', 'Peripheral Subcutaneous Field Stimulation', or 'PSFS' adjacent to CPT 64999 and whether the procedure is permanent or trial in the comment/narrative field (e.g., Loop 2400 or SV101-7 for 5010A1 837P; Item 19 for paper claims).
- For Part A claims enter 1 UOS and include the text 'Peripheral Nerve Field Stimulation', 'PNFS', 'Peripheral Subcutaneous Field Stimulation', or 'PSFS' adjacent to CPT 64999 and whether the procedure is permanent or trial in the comment/narrative field (e.g., Line SV02-7 for 837I electronic claims; Block 80 on the UB-04 form).
Key Coverage Criteria
- 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.
- Botulinum toxin is indicated to reduce spasticity or excessive skeletal muscle contractions (including dystonia, spasticity, hemifacial spasm) to relieve pain, improve posture/walking, increase range of motion, assist physical therapy, and reduce severe spasm for perineal hygiene.
- Botulinum toxin injection therapy is accepted first-line treatment for blepharospasm and/or hemifacial spasm.
- Botulinum toxin may be considered for achalasia in patients who have not responded to conventional therapy, are high risk for pneumatic dilation or surgical myotomy, have had prior pneumatic dilation failure or perforation, or have an epiphrenic diverticulum, hiatal hernia, or esophageal varices.
- Botulinum toxin may be considered for chronic anal fissure in patients who have not responded satisfactorily to conventional therapy.
11 Active Policies
AMBETTER-CP.VP.63 — Visual Field Testing
A55531 — Billing and Coding: Peripheral Nerve Stimulation
AETNA-CPB-0100 — Cryoablation
AETNA-CPB-0462 — Headaches: Nonsurgical Management
AETNA-CPB-0647 — Histamine Desensitization Therapy for Intractable Headaches
Related Codes
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