Does G93.42 require prior authorization?

No, G93.42 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G93.42` — Megalencephalic leukoencephalopathy with subcortical cysts

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.
When billing CPT 95905 for carpal tunnel, the diagnosis code must be G56.01 or G56.02.
Data gathered during NCS should be available to support the claim, although it is not necessary to include documentation with every claim submission.
Providers are expected to use CPT 95870 for sampling muscles other than paraspinals associated with tested extremities; CPT 95870 should not be billed for paraspinal sampling when extremity EMG codes 95860, 95861, 95863, or 95864 are also billed.

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.
Electrodiagnostic nerve conduction studies and electromyography that provide real-time response parameters (amplitude, latency, configuration, conduction velocity) are acceptable for Medicare payment and should be used for provider interpretation.
Botulinum toxin injections are covered when medical necessity is documented according to the Local Coverage Determination (LCD) 'Botulinum Toxin Types A and B' Indications and Limitations of Coverage.

A56612 — Billing and Coding: CT of the Head

A56619 — Billing and Coding: Nerve Conduction Studies and Electromyography

A57185 — Billing and Coding: Botulinum Toxin Types A and B

A57186 — Billing and Coding: Botulinum Toxin Types A and B

L34417 — CT of the Head

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