G93.45 — Developmental and epileptic encephalopathy
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Billing, coding, and documentation must comply with the Local Coverage Determination L37638 referenced by this policy.
- 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.
Key Coverage Criteria
- Health and behavior assessment and intervention services are covered when they meet the coverage criteria and documentation requirements specified in Local Coverage Determination L37638.
- 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.
14 Active Policies
L34771 — Immune Globulins
J05
A57554 — Billing and Coding: Immune Globulins
J05
A56612 — Billing and Coding: CT of the Head
A56619 — Billing and Coding: Nerve Conduction Studies and Electromyography
A56771 — Billing and Coding: Special Electroencephalography
Related Codes
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