G50.9 — Disorder of trigeminal nerve, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- 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.
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.
- Automated nerve conduction testing using the NC-stat (CPT 95905) is allowed only when there is a high pre-test or prior probability of carpal tunnel syndrome and the claim uses diagnosis code G56.01 or G56.02; allowed one service per arm.
- If authorized by state law, physical therapists (PTs) are allowed to perform the technical and professional components of nerve conduction studies represented by CPT codes 95907-95913 consistent with a 7A supervision designation (effective 01/01/2013).
- If authorized by state law, the technical component of neuromuscular junction testing CPT 95937 (TC) with supervision designation 7A is allowable for PTs consistent with the 7A description (effective 01/01/2013).
- Needle electromyography CPT codes 95860-95872 and 95885-95887 have a 6A designation for the technical portion; PTs who are ABPTS-certified as qualified electrophysiologic clinical specialists and are authorized by state law may perform the technical and professional components according to the 6A description.
18 Active Policies
L35098 — Nerve Conduction Studies and Electromyography
J06
A56874 — Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
J06
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
L35076 — Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
J06
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