Does G51.8 require prior authorization?

No, G51.8 does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`G51.8` — Other disorders of facial nerve

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Medical record must document medical necessity, relevant history, physical exam, and results of pertinent diagnostic tests supporting botulinum toxin use and must reference the covered diagnosis.
For spastic conditions other than upper/lower-limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia or other focal dystonias, documentation must state unresponsiveness to conventional treatment and include dosage, injection site(s), frequency, EMG necessity (if used), and effectiveness.
Claims must report referring/ordering physician name and NPI when required by the service, and a valid ICD-10-CM code that best describes the treated condition must be present on the claim.
Documentation must show exact drug dosage administered, reason for unavoidable wastage, and amount discarded; split-vial use must document amounts given to each patient and pro rata wastage calculation details.

Key Coverage Criteria

Botulinum toxin injections are covered for limb spasticity, including upper- and lower-limb spasticity, when medically necessary.
Botulinum toxin injections are covered for blepharospasm when medically necessary.
Botulinum toxin injections are covered for hemifacial spasm when medically necessary.
Botulinum toxin injections are covered for cervical dystonia when medically necessary.
Botulinum toxin injections are covered for other focal dystonias when medically necessary.
Electromyography (EMG) guidance for injection needle placement is covered when medically necessary and billed with appropriate CPT codes (e.g., 95873; 95874 when not billed with 95873).

20 Active Policies

L34635 — Botulinum Toxin Type A & Type B

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

A57474 — Billing and Coding: Botulinum Toxin Type A & Type B

J05

L33646

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When billing discarded drug amounts to Medicare, use -JW modifier on a separate line with appropriate units rounded to the nearest unit such that total billed does not exceed vial contents; effective July 1, 2023 use JZ when no discarded amount.

Providers must maintain documentation of reconstitution and waste and be prepared to supply documentation or peer-reviewed literature upon contractor request for case-by-case determinations.

— Botulinum Toxins

A52848 — Billing and Coding: Botulinum Toxins

J06

A56874 — Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

J06

L35098 — Nerve Conduction Studies and Electromyography

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

A57123 — Billing and Coding: Nerve Conduction Studies and Electromyography

J09

L34859 — Nerve Conduction Studies and Electromyography

J09

A56773 — Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

J12

A54095 — Billing and Coding: Nerve Conduction Studies and Electromyography

J12

L34975 — Neurophysiology Evoked Potentials (NEPs)

J12

L35081 — Nerve Conduction Studies and Electromyography

J12

A56868 — Billing and Coding: Outpatient Speech Language Pathology

A54969 — Billing and Coding: Nerve Conduction Studies and Electromyography

A56646 — Billing and Coding: Chemodenervation

A59820 — Billing and Coding: Radiation Therapies

G51.8 — Other disorders of facial nerve