Does G47.09 require prior authorization?

No, G47.09 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G47.09` — Other insomnia

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.
When billing Part B claims, include the drug(s) being considered that require the PGx test on the applicable detail line (eg, 2400 loop on 837P); for Part A include Loop SV202-7 (837I) or Block 80 (UB04); for paper Part B include Box 19.

CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
Pharmacogenomics (PGx) testing is covered when it is reasonable and necessary per LCD L39063 and Medicare coverage rules for the beneficiary's clinical indication.
CPT 81418 (PGx multi-gene panel) is covered when the test assays at least 6 genes, including CYP2C19 and CYP2D6 and CYP2D6 duplication/deletion analysis, and the panel is clinically indicated to guide drug therapy.
A clinician-ordered single gene or allele test is considered covered when the billed component corresponds to the single gene/allele that was reasonable and necessary, even if the laboratory platform concurrently interrogated other genes operationally.
Germline testing panels that include some previously tested genetic content may be covered if there is established clinical utility for the remaining non-duplicative genetic components of the panel.

A59914 — Billing and Coding: Pharmacogenomic Testing

J06

L39995 — Pharmacogenomic Testing

J06

A59915 — Billing and Coding: Pharmacogenomic Testing

J06

L39073 — Pharmacogenomics Testing

J09

A58812 — Billing and Coding: Pharmacogenomics Testing

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