Does G57.91 require prior authorization?

No, G57.91 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G57.91` — Unspecified mononeuropathy of right lower limb

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When NCSs and NEMG are performed on the same day for the same patient they must be reported on the same claim.
When billing non-covered services/tests report unlisted neurological CPT 95999 and provide a description of the service/test in block 80 (Part A) or box 19 (Part B) or electronic equivalent; failure to include this information will result in Part A claims being returned and Part B claims rejected.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.
The submitted medical record must support the selected ICD-10-CM code(s), the submitted CPT/HCPCS code must describe the service performed, and the record must clearly document the medical necessity, the indication for ordering the test(s), and a clear diagnostic impression.

Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53 is reported.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
Medicare covers manual manipulation of the spine (chiropractic manipulative treatment) for treatment of spinal subluxation using CPT codes 98940, 98941, or 98942 when medically necessary.
Subluxation must be demonstrated and documented (by x-ray or physician/chiropractic exam) with the problem/complaint addressed and the precise level of each subluxation treated specified in the medical record.

L39986 — MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

J05

A59905 — Billing and Coding: MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

J05

L39987 — MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

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